Healthcare EDI Global Market Report 2024

Electronic Data Interchange (EDI) serves as the software conduit facilitating data transactions among diverse healthcare stakeholders and insurers through computer systems. Utilizing the EDI service, organizers can efficiently process and monitor claims throughout the entire billing cycle. Healthcare EDI plays a pivotal role in managing critical patient data, encompassing medical history, medication information, and emergency services records.

Key transactions within healthcare EDI involve claim management, healthcare supply chain, and other related processes. Claim management entails the organization, billing, filing, updating, and processing of healthcare claims associated with patient diagnoses, medications, and treatments. This encompasses various components such as software, hardware, and services, delivered through modes like mobile, VAN, web & cloud-based, and point-to-point. These solutions are employed by healthcare providers, payers, pharmacies, and other end users in the industry.

The healthcare EDI market research report is one of a series of new reports that provides healthcare EDI market statistics, including healthcare EDI industry global market size, regional shares, competitors with a healthcare EDI market share, detailed healthcare EDI market segments, market trends and opportunities, and any further data you may need to thrive in the healthcare EDI industry. This healthcare EDI market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.

The healthcare edi market size has grown rapidly in recent years. It will grow from $4.58 billion in 2023 to $5.07 billion in 2024 at a compound annual growth rate (CAGR) of 10.7%. During the historical period, the growth can be ascribed to factors such as adherence to regulatory compliance, improvements in administrative efficiency, cost reduction initiatives, and the minimization of errors in claims processing.

The healthcare edi market size is expected to see rapid growth in the next few years. It will grow to $7.84 billion in 2028 at a compound annual growth rate (CAGR) of 11.5%. In the forecast period, the anticipated growth is linked to the expansion of telehealth, the standardization of data, advancements in data privacy and security, increased inter-organizational data sharing, and heightened preparedness for pandemics. Key trends expected during this period encompass the establishment of interoperability standards, the automation of prior authorization processes, the utilization of blockchain for secure data exchange, the implementation of mobile EDI solutions, and the integration of artificial intelligence for enhanced scrutiny of claims.

Government backing for healthcare is anticipated to drive the expansion of the healthcare Electronic Data Interchange (EDI) market. This technology facilitates information exchange within different sections of super-specialty hospitals. The healthcare EDI software plays a crucial role in transmitting essential details such as coordination of benefits, claims status, insurance data, payment data, and eligibility forms among healthcare entities. Increased government support for the healthcare sector contributes to the development of new equipment and enhanced services, fostering technological advancements in government hospitals. For instance, the Indian Economic Survey reported an increase in India's public healthcare spending from 1.8% in 2020-21 to 2.1% in 2021-22, and the Union budget for 2022 allocated 11.28 billion for healthcare growth. This heightened government support propels the demand for the healthcare EDI market.

The healthcare EDI market is poised for growth with the expansion of telehealth services. Telehealth, encompassing various aspects of healthcare through computerized information and communications technology, facilitates remote health services delivery. Healthcare Electronic Data Interchange (EDI) plays a pivotal role in supporting telehealth by optimizing administrative and data exchange processes. This, in turn, enhances patient-provider communication and ensures secure and efficient sharing of crucial healthcare data, contributing to the effectiveness and affordability of telehealth services. Notably, the Australian Digital Health Agency reported a surge in telehealth therapy services, with 118.2 million services provided to 18 million individuals between March 2020 and July 2022. The increased adoption of telehealth services is a driving force for the healthcare EDI market.

Technological advancements emerge as a prominent trend in the healthcare EDI market. Key market players focus on innovation to maintain their market position. For example, in May 2022, NextGen Healthcare Inc., a US-based software company specializing in electronic health record software, introduced NextGen Health Data Hub Insights. This innovative data warehouse and analytics solution simplify data access, analytics, and report production for health information exchanges (HIEs) and healthcare providers in the United States. The platform, an extension of the NextGen Health Data Hub, enables users to unleash the value of their data assets by providing customized, near-real-time reporting capabilities and insights at the point of treatment. Technological advancements like these shape the landscape of the healthcare EDI market.

In July 2022, Technology Partners LLC, doing business as ImagineSoftware, a US-based software company, successfully acquired Exchange EDI LLC in a deal of undisclosed value. This strategic move has expanded ImagineSoftware's service portfolio, incorporating Exchange EDI's capabilities to enhance patient billing and collections operations. The amalgamation of their technologies and expertise positions both companies optimally to enhance communication between doctors and patients. Exchange EDI LLC, a US-based company specializing in the electronic interchange of business information using standardized formats, now operates under the ImagineSoftware umbrella.

In October 2022, Change Healthcare Inc., a US-based company operating in the healthcare electronic data interchange sector, announced the successful completion of a merger. This union brings together two companies with a shared objective of creating a simpler, more intelligent, and adaptable health system for individuals, payers, and providers. The integrated approach aims to streamline critical clinical, administrative, and financial procedures essential for healthcare professionals and payers in patient treatment. By enhancing efficiency and reducing friction, the unified entity anticipates benefiting the entire healthcare system, leading to cost savings and increased satisfaction for all stakeholders. Notably, Optum Inc., a US-based healthcare technology and EDI company, is a key player in this sector.

Major companies operating in the healthcare edi market include McKesson Corporation, Optum Inc., Allscripts, GE Healthcare, Cognizant Technology Solutions India Pvt Ltd., Cerner Corporation, Dell Technologies Inc., The SSI Group, Tallan Inc., Quadax Inc., AthenaHealth, Schreiner Group, MuleSoft LLC, Boomi Inc., Change Healthcare Inc., Conduent Inc., Epic Systems Corporation, Siemens Healthineers, NextGen Healthcare, Infor Inc., Edifecs Inc., Waystar Inc., Experian Information Solutions Inc., Availity LLC, eClinicalWorks, National Education Association, Ability Network, PracticeSuite Inc., Quest Diagnostics, Jopari Solutions Inc., Alpha II LLC, TransUnion Healthcare, Bizmatics Inc., Healthpac Computer Systems

North America was the largest region in the healthcare EDI market in 2023. Asia-Pacific is expected to be the fastest-growing region in the forecast period. The regions covered in the healthcare EDI market analysis report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, Middle East and Africa.

The countries covered in the healthcare EDI market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA.

The healthcare electronic data interchange (EDI) market includes revenues earned by Web & Cloud-based EDI, EDI Value Added Network, Direct EDI and Mobile EDI. The market value includes the value of related goods sold by the service provider or included within the service offering. Only goods and services traded between entities or sold to end consumers are included.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.


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