The healthcare claims management solutions are used for optimization, organization, billing, and updating the medical claims related to patients’ diagnosis, treatment, and medications. Different types of software solutions are applied for the medical claims for customer or patients. The widely used software include, Waystar, Kareo, TriZettoQNXT, NextGenHealthcare HER, eClinicalWorksRCM, anthenaCollector, Availity, AdvancedMD. A healthcare insurance claim request of the patient is submitted to the insurance company to obtain services from insurance company, which is done using software. The advantages of healthcare claim management system include, increase in efficiency and accuracy, improved organization-wide communication and accountability, and healthcare analytics that inform strategy and action for the patients.
Increase in prevalence of chronic disease, changed lifestyle, and technological advancements in healthcare claims management solutions drive the market growth. In addition, rise in geriatric population globally boosts the market growth. Increase in latest and advanced software, development in healthcare claim management initiatives and centers for diagnosis, and increase in the number of patients with chronic diseases are factors that drive the growth of the market. Increasing concerns regarding the patient data safety & and security increase the threat of cyber-attacks and the potential misuse of patient-related confidential data, which hinders the growth of healthcare claims management solution market. Increase in investment in the Asia-Pacific region offers huge market potential advanced techniques for the growth of the market. Thus, rise in investments in emerging markets to improve healthcare IT infrastructure from various government agencies is expected to create opportunities in the healthcare claims management solutions market.
The healthcare claims management market is segmented on the basis of type, deployment mode, and geography. By type, the market is segmented into software and services. On the basis of deployment mode, the market is segmented into web-based mode, cloud-based mode, and on-premise. By geography, the market is segmented into North America, Europe, Asia-Pacific, and LAMEA.
The key players profiled in the report include, Oracle Corporation, ALLISCRIPTS HEALTHCARE SOLUTIONS, Athenahealth Inc., COGNIZANT Technology Solution Corporation, Quest Diagnostics, McKesson Corporation, eClinicalWorks LLC, Optum, Inc., The SSI Group, Inc., and GE Healthcare.
Key Benefits For Stakeholders
- This report provides a quantitative analysis of the healthcare claims management solutions industry, market segments, current trends, estimations, and dynamics of the healthcare claims management solutions market analysis from 2020 to 2030 to identify the prevailing healthcare claims management solutions market opportunities.
- The market research is offered along with information related to key drivers, restraints, and opportunities.
- Porter's five forces analysis highlights the potency of buyers and suppliers to enable stakeholders make profit-oriented business decisions and strengthen their supplier-buyer network.
- In-depth analysis of the healthcare claims management solutions market segmentation assists to determine the prevailing market opportunities.
- Major countries in each region are mapped according to their revenue contribution to the global market.
- Market player positioning facilitates benchmarking and provides a clear understanding of the present position of the market players.
- The report includes the analysis of the regional as well as global healthcare claims management solutions market trends, key players, market segments, application areas, and market growth strategies.
Key Market Segments
By Type
- Software
- Services
By Deployment Mode
- Web-based
- Cloud-based
- On-premise
By Region
- North America
- U.S.
- Canada
- Mexico
- Europe
- France
- U.K.
- Italy
- Spain
- Rest of Europe
- Germany
- Asia-Pacific
- Japan
- China
- Australia
- India
- South Korea
- Rest of Asia-Pacific
- LAMEA
- Brazil
- Saudi Arabia
- South Africa
- Rest of LAMEA
Key Market Players
- Oracle Corporation
- Allscripts Healthcare Solutions, Inc.
- Athenahealth Inc.
- COGNIZANT TECHNOLOGY SOLUTIONS CORPORATION
- Quest Diagnostics
- McKesson Corporation
- eClinicalWorks LLC
- Optum, Inc,
- The SSI Groups Inc.
- GE Healthcare
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Table of Contents
Executive Summary
According to this report titled, 'Healthcare Claims Management Solutions Market,' the healthcare claims management solutions market size was valued at $12.7 billion in 2020, and is estimated to reach $20.3 billion by 2030, growing at a CAGR of 4.7% from 2021 to 2030.Healthcare claim management system involves the different tasks such as organization, billing, filling, updating, and processing of the medical claims related to treatment, diagnosis, and medication of the patient. It is easy to implement and make whole procedure of claims creation, claim processing, and claims submission by electronic claim management system by using claim management software. Different types of claim management software are available for patients to encourage loyalty by allowing quick and accurate process to resolve claims as fast as possible. Healthcare claims management software is used to streamline the medical claims process, which eases the relationship between providers and insurance companies and efficiently and quickly improves the patient payment lifecycle. Medical billing software, revenue cycle management software, and medical practice management software are some of the healthcare claim software that are available for customers and are applicable for payers, healthcare providers, and insurance providers for management system.
The key factor responsible for healthcare claims management solutions market growth include, increase in geriatric population, rise in incidence of chronic diseases, growth in awareness for care provision, proactive government initiatives to improve insurance coverage among citizens, and surge in use of cloud-based services. Increase in concerns regarding the patient data safety & security owing to increase in threat of cyber-attacks and the potential misuse of patient related confidential data hinders the growth of healthcare claims management solution market growth. Increase in investment in the Asia-Pacific region offers advanced claim management solutions techniques, which are expected to offer growth opportunities in the future. Thus, rise in investments in emerging markets to improve healthcare IT infrastructure from various government agencies is expected to create opportunities in the healthcare claims management solutions market.
The healthcare claims management solutions industry is segmented on the basis of type, deployment mode, and geography. By type, the market is segmented into software and services. On the basis of deployment mode, the market is segmented into web-based mode, cloud-based mode, and on-premise mode. By geography, the market is segmented into North America, Europe, Asia-Pacific, and LAMEA.
Key players with healthcare claims management solutions market share profiled in the report are Oracle Corporation, ALLISCRIPTS HEALTHCARE SOLUTIONS, ATHENAHEALTH INC. COGNIZANT Technology Solution Corporation, Quest Diagnostics, McKesson Corporation, eClinicalWorks LLC, Optum, Inc., The SSI Group, Inc., and GE Healthcare.
By type, the market is segmented into software, and services. The software segment dominated the global healthcare claims management solutions market in 2020. This software provides an easy solution for all the tedious and time consuming claims management activities, such as eligibility crosschecking, benefit administration, premium billing, care management, claims processing, overpayment recovery, capitation, subrogation, customer service/contact management, fulfillment, reporting, and more.
By deployment mode, the healthcare claims management solutions market size is segmented into web-based mode, cloud-based mode, and on-premise deployment mode. The web-based deployment mode dominated the global healthcare claims management solutions market in 2020. It is provides the flexibility and can be accessed anywhere, anytime. Due to these benefits, the web-based deployment mode is highly adopted and preferred.
The report provides comprehensive healthcare claims management solutions market analysis. By geography, it is segmented as North America, Europe, Asia-Pacific and LAMEA. North America was the highest contributor to the global market in 2020. Asia-Pacific is projected to grow at a significant CAGR of 5.7% during the healthcare claims management solutions market forecast. However, Asia-Pacific is expected to emerge as the region with maximum growth potential due to focus of key players in emerging economies, improving healthcare infrastructure, and rising disposable income of middle class population in the region.
KEY FINDINGS OF STUDY
- The study provides an in-depth analysis of the healthcare claims management solutions industry, and the current trends & future estimations to elucidate imminent investment pockets.
- By type, the software segment was the highest contributor to the market in 2020.
- By deployment mode, the web-based segment dominated the market in 2020 and is expected to continue this trend during the forecast period.
- Region-wise, North America garnered the largest revenue share in 2020. However, Asia-Pacific is anticipated to grow at the highest CAGR during the forecast period.
Companies Mentioned
- Oracle Corporation
- Allscripts Healthcare Solutions, Inc.
- Athenahealth Inc.
- COGNIZANT TECHNOLOGY SOLUTIONS CORPORATION
- Quest Diagnostics
- McKesson Corporation
- eClinicalWorks LLC
- Optum, Inc
- The SSI Groups Inc.
- GE Healthcare
Methodology
The analyst offers exhaustive research and analysis based on a wide variety of factual inputs, which largely include interviews with industry participants, reliable statistics, and regional intelligence. The in-house industry experts play an instrumental role in designing analytic tools and models, tailored to the requirements of a particular industry segment. The primary research efforts include reaching out participants through mail, tele-conversations, referrals, professional networks, and face-to-face interactions.
They are also in professional corporate relations with various companies that allow them greater flexibility for reaching out to industry participants and commentators for interviews and discussions.
They also refer to a broad array of industry sources for their secondary research, which typically include; however, not limited to:
- Company SEC filings, annual reports, company websites, broker & financial reports, and investor presentations for competitive scenario and shape of the industry
- Scientific and technical writings for product information and related preemptions
- Regional government and statistical databases for macro analysis
- Authentic news articles and other related releases for market evaluation
- Internal and external proprietary databases, key market indicators, and relevant press releases for market estimates and forecast
Furthermore, the accuracy of the data will be analyzed and validated by conducting additional primaries with various industry experts and KOLs. They also provide robust post-sales support to clients.
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Table Information
Report Attribute | Details |
---|---|
No. of Pages | 210 |
Published | April 2022 |
Forecast Period | 2020 - 2030 |
Estimated Market Value ( USD | $ 12690.3 million |
Forecasted Market Value ( USD | $ 20284.18 million |
Compound Annual Growth Rate | 4.8% |
Regions Covered | Global |
No. of Companies Mentioned | 10 |