Healthcare Claims Management Market Size was valued at USD 14.9 billion in 2022. The Healthcare Claims Management market industry is projected to grow from USD 15.5705 Billion in 2023 to USD 22.13 billion by 2032, exhibiting a compound annual growth rate (CAGR) of 4.5% during the forecast period (2024 - 2032).The market for healthcare claims management is the home to numerous market operations associated with the medical industry. These procedures cover various responsibilities and market demands, including patient scheduling, billing, filing, updating, and processing medical claims linked to diagnosis, treatment, and medication are the key market drivers enhancing the market growth.
Source Secondary Research, Primary Research, MRFR Database and Analyst Review
March 2024: UnitedHealth Group initiated testing on Monday, March 2024, at its Change Healthcare division its restored medical claims platform, nearly four weeks after a cyberattack forced the company to disconnect systems. However, returning to normalcy will not be as straightforward as toggling a switch. The insurance behemoth, whose Optum subsidiary owns Change, announced that thousands of clients would have access to claims preparation software within the coming days. Change operates over a hundred platforms, including claims management services, which have been inoperable since February 21, when the ALPHV/BlackCat ransomware group launched an attack. As a result, substantial portions of the healthcare industry have been unable to generate revenue. Certain critical services have been reinstated. Friday marked the return online of Change's electronic payments platform, according to UnitedHealth, which is currently coordinating implementations with payers.
March 2024: Machinify unveiled a suite comprising three artificial intelligence (AI) applications in March 2024, with the explicit purpose of managing the complete healthcare claims lifecycle. The applications encompass the entire process, from prior authorization to final payments, according to a press release from the AI-driven, healthcare administration-focused company. The potential for utilizing AI to revolutionize the economics of healthcare is immense. Leading the way, Machinify integrates enterprise-scale software, purpose-built artificial intelligence, and profound domain expertise into a single, interconnected offering.
November 2023: Unexpectedly, CoverSelf, a pioneer in the HealthTech industry, has successfully secured $8.2 million in initial funding. Situated amidst the dynamic and perpetually progressing healthcare sector, CoverSelf distinguishes itself as a unified platform committed to augmenting the precision of healthcare claims and ensuring payment integrity. BEENEXT and 3one4 Capital spearheaded this infusion of capital; Z21 Ventures and a number of healthtech industry executives also made contributions. The diverse range of current and prospective investors serves as evidence of the widespread trust in CoverSelf's mission and competencies. Fundamentally, CoverSelf transcends its technological nature and signifies a fundamental transformation in the manner in which healthcare claims and payments are managed.
Technological innovations pertinent to healthcare solutions and software, along with the escalating demand for automation in healthcare, can translate into a considerable need for healthcare claims management in the ensuing years. The surge in R&D and the notable rise in chronic and infectious conditions worldwide means essential medical data and records, which should heighten market demand. Massive funding from governments to improve the quality of healthcare services and enhance healthcare infrastructure should further ensure sustained healthcare claims management.
The worldwide healthcare claims management market study aims to analyze the market based on the market dynamics, such as drivers and constraints, for the forecast period ending in 2028. For a booming market to operate during the term, these criteria aid in predicting the healthcare claims management market CAGR rate and the end market value. The AI healthcare claims management company report aids in the analysis of the healthcare claims management market segmentation that operates in various regions and, as a result, has a significant impact on encouraging the major players to implement innovative strategies and heighten the already intense competition in the healthcare claims management market. By observing the actions taken, the market report aids in analyzing the scope present during the time ending in 2028.
However, claims management devices are being appreciated by a large range of customers implants is another factor driving the growth of the Healthcare Claims Management market revenue.
The Healthcare Claims Management market segmentation, based on component divided into segments software and Services segment. Software segment accounted for the most significant revenue share of over 65.0% in 2022. The part is expected to maintain its dominance throughout the projected period. The healthcare industry has been revolutionized by overall digitization, improving patient treatment guiding systems and software technologies that offer accessible healthcare data through effective automated billing and claims processing systems. Medical billing and claims processing software have several advantages, including more accurate bills, fewer administrative errors, fewer insurance claim denials, invoice tracking, and speedier payments, which boosts efficiency and accuracy even more.
Figure 1 Healthcare Claims Management Market, by Component, 2022& 2030 (USD Billion)
Source Secondary Research, Primary Research, MRFR Database and Analyst Review
The Healthcare Claims Management market segmentation, based on type include sub-segments Integrated and Standalone. Integrated solutions category dominated the market with a revenue share of over 70.0% in 2022. It is predicted to anticipate its dominance throughout the forecast period. Navigating complex insurance requirements, recognizing best practices for data collection, and analyzing data to find possibilities for improvement are skills that are unrelated to patient care but equally critical for any healthcare institution that wants to stay in business. For the above reasons, providers constantly look for methods to improve claim management and medical billing systems. Thus, implementing an integrated billing and claims processing system, which offers several benefits, is one method.
The Healthcare Claims Management market data based on deployment mode On-Premise and Cloud Based. The on-premise held the largest share. Healthcare claims management systems that are deployed on-premises have some advantages, such as better data protection and control, as well as the ability to modify the software to suit unique organisational requirements. Additionally, companies that manage sensitive patient data or have strict regulatory compliance requirements may benefit more from on-premise deployment.
The Healthcare Claims Management market data based on end use is Healthcare Payers and Providers anticipated to rise moderately over the forecast period, with growth aided by adopting rigorous regulatory rules in various countries such as the U.S. Due to IT infrastructure limits in emerging nations, the healthcare providers segment has faced challenges. This is mainly because the price impedes the adoption of advanced technology, such as claims processing software.
Ministry of Health & Family Welfare to improve the insurance coverage of their citizens and adoption of cloud technology-related services offers a lucrative healthcare claims management solutions market opportunity. Improved focus on healthcare systems and advancement in technology for innovative treatments drive the growth of the healthcare claims management solutions market forecast.
The COVID-19 pandemic has had a mixed impact on the overall market. Furthermore, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was designed in developed countries such as the U.S. to provide healthcare resources required to combat COVID-19. The CARES Act incorporated medical billing rules, which increased claim denials and their management. This will further boost the overall market for medical billing and healthcare claims management industry.
By Region, the study provides the market insights into North America, Europe, Asia-Pacific and Rest of the World. North America Health care Claims Management market accounted for USD 14.9 billion in 2022 and is expected to exhibit a significant CAGR growth during the study period due to the substantial amount of medical insurance claims that are handled in the nation. The industry is expanding, though, as more electronic claims processing systems are adopted and as the infrastructure for healthcare IT grows.
Further, the major countries studied in the market report are The U.S, Canada, Germany, France, UK, Italy, Spain, China, Japan, India, Australia, South Korea, and Brazil.
Figure 2 HEALTHCARE CLAIMS MANAGEMENTMARKET SHARE BY REGION 2022 (%)
Source Secondary Research, Primary Research, MRFR Database and Analyst Review
Europe Healthcare Claims Management market accounts for the second-largest market share due to the healthcare coverage, adopting EHRs and e-prescribing services, growing government spending, and improving healthcare infrastructure. Further, the Germany Healthcare Claims Management market held the largest market share, and the UK Healthcare Claims Management market was the fastest growing market in the European region
The Asia-Pacific Healthcare Claims Management Market is expected to grow at the fastest CAGR from 2022 to 2030. One of the main drivers of this development is the rising adoption of healthcare IT solutions, along with rising healthcare costs and an increase in the prevalence of chronic diseases. Additionally, a number of regional governments are launching programmes to promote the use of healthcare IT solutions, which is further boosting the market for healthcare claims administration. Moreover, China Healthcare Claims Management market held the largest market share, and the India Healthcare Claims Management market was the fastest growing market in the Asia-Pacific region
Healthcare Claims Management Key Market Players& Competitive Insights
Major market players are spending a lot of money on R&D to increase their product lines, which will help the Healthcare Claims Management market, grow even more. Market participants are also taking a range of strategic initiatives to grow their worldwide footprint, with key market developments such as new product launches, contractual agreements, mergers and acquisitions, increased investments, and collaboration with other organizations. Competitors in the Healthcare Claims Management industry must offer cost-effective items to expand and survive in an increasingly competitive and rising market environment.
Many software companies have given medical billing and claims processing software and this is very profitable area in the Healthcare Claims Management industry to benefit clients and expand the market sector. In recent years, Healthcare Claims Management industry has provided software & web-based services with some of the most significant benefits. The Healthcare Claims Management t market major player such as Cerner Corporation, McKesson Corporation, Accenture plc., Genpact Limited,eClinicalWorks,Cognizant Technology Solutions Corporation,Oracle Corporation,IBM Corporation, Conifer Health Solutions.
Modern technologies such as cloud, mobile, and next-generation databases are increasingly used to manage, store, and retrieve claims data as technology advances. These elements have conspired to form healthcare data and concern for the healthcare industry. To guarantee that patients have the data protection they need and deserve, rules and regulations governing healthcare data are constantly evolving.
The National Health Expenditure Account (NHEA) has formulated statistics related to the healthcare claims management market. The stats suggest that U.S. healthcare spending is likely to grow. The market is further witnessing an increase in the degree of funding and investment in the healthcare infrastructure and services prevalent in the Asia-Pacific region. The players in this region offer a vast market potential for the players to grow in the healthcare claims management solutions market during the ongoing forecast period. The market trends are expected to bloom during the forecast period of 2022-2030 owing to the proactive government initiatives to spread awareness, and correct information about the benefits of this technology among the masses have supplemented the healthcare claims management market growth.
Key Companies in the Healthcare Claims Management market includes
Healthcare Claims Management Industry Developments
The stats suggest that U.S. healthcare spending is likely to grow. The market is further witnessing an increase in the degree of funding and investment in the healthcare infrastructure and services prevalent in the Asia-Pacific region. The players in this region offer a vast market potential for the players to grow in the healthcare claims management solutions market during the ongoing forecast period.
The market trends are expected to bloom during the forecast period of 2022-2030 owing to the proactive government initiatives to spread awareness, and correct information about the benefits of this technology among the masses have supplemented the healthcare claims management market growth.
| Report Attribute/Metric | Details |
| Market Size2022 | USD 14.9billion |
| Market Size 2023 | USD 15.5705 billion |
| Market Size 2030 | USD 22.13 billion |
| Compound Annual Growth Rate (CAGR) | 4.5% (2023-2032) |
| Base Year | 2023 |
| Market Forecast Period | 2024-2032 |
| Historical Data | 2019- 2022 |
| Market Forecast Units | Value (USD Billion) |
| Report Coverage | Revenue Forecast, Market Competitive Landscape, Growth Factors, and Trends |
| Segments Covered | Component, Delivery mode type and End-user |
| Geographies Covered | North America, Europe, AsiaPacific, and Rest of the World |
| Countries Covered | The U.S, Canada, Germany, France, UK, Italy, Spain, China, Japan, India, Australia, South Korea, and Brazil |
| Key Companies Profiled | Cerner Corporation, McKesson Corporation, Accenture plc., Genpact Limited,eClinicalWorks,Cognizant Technology Solutions Corporation,Oracle Corporation,IBM Corporation, Conifer Health Solutions. Â |
| Key Market Opportunities | New product launches and R&D Amongst major key Players |
| Key Market Dynamics | Increase in ageing population Rise in incidence of chronic diseases Improved focus on healthcare quality services Advent of innovative treatments & technologies |
Frequently Asked Questions (FAQ) :
The Healthcare Claims Management market size was valued at USD 14.9 Billion in 2022.
The market is projected to grow at a CAGR of 4.5% during the forecast period, 2023-2032.
North America had the largest share in the market
The key players in the market are Cerner Corporation, McKesson Corporation, Accenture plc., Genpact Limited,eClinicalWorks,Cognizant Technology Solutions Corporation,Oracle Corporation,IBM Corporation, Conifer Health Solutions.
Healthcare Claims Management Market would find the Asia Pacific as the fastest-growing region.
Healthcare claims management solutions are used across various healthcare facilities to simplify the process of billing, filling, updating, and processing of medical claims related to the diagnosis, treatment, and medication of patients.
Research Analyst Level I He is an extremely curious individual currently working in healthcare and medical devices domain. kinjoll is comfortably versed in data centric research backed by healthcare educational background. he leverages extensive data mining and analytics tools such as primary and secondary research, statistical analysis, machine learning, data modelling. his key role also involves technical sales support, client interaction and project management within the healthcare team. lastly, he showcases extensive affinity towards learning new skills and remain fascinated in implementing them.
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