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Healthcare Claims Management Market

Healthcare Claims Management Market Size, Share & Segment by Component (Software, Services), By Type (Integrated Solutions, Standalone Solutions), By Delivery Mode (On-premise, Cloud-based), By End User (Healthcare Payers, Healthcare Providers), by Regions and Global Forecast 2022-2028

Report Id: SNS/HC/2194 | July 2022 | Region: Global | 131 Pages

Healthcare Claims Management Market Size was valued at USD 12.77 billion in 2021, and is expected to reach USD 19.08 billion by 2028, and grow at a CAGR of 5.9% over the forecast period 2022-2028.

 

Medical claims linked to patient diagnosis, treatment, and prescription are organized, billed, filled out, updated, and processed as part of the healthcare claims management process. In other words, it is software that controls medical claims and payment processes that is increasingly enabling healthcare providers to maximize their profits through appropriate claim management. It is typically a healthcare professional, billing companies, bilateral process between patients, and insurance carriers. Due to the healthcare insurance industry's quick growth, the market for claims management is expanding quickly.

Healthcare Claims Management Market

MARKET DYNAMICS

DRIVERS

  • Patient Volumes Are Growing

  • Health Insurance Market is Growing

  • Enhancements to Process in Healthcare Organizations

  • Denials Management's Increasing Relevance

  • Declining Payment Rates

 

RESTRAINTS

  • Exorbitant Deployment Costs

 

OPPORTUNITIES

  • Emerging States

  • Solutions Based in the Cloud

  • Expanding Use of Electronic Health Records

 

CHALLENGES

  • Combining Claim Management Products

  • Loss of Privacy and Data Breach

  • Lack of Healthcare IT Experts with the Necessary Skill

 

IMPACT OF COVID-19

Since the pandemic began affecting people's lives all across the world, this management software has provided excellent assistance. People are having a difficult time adjusting to the new normal tendencies since the pandemic has spread globally. Furthermore, there have been significant disruptions to markets and enterprises. Major difficulties for the operation of a variety of markets that have developed since the pandemic's spread include the lack of labor, raw supplies, and investment. These have an effect on the manufacturing and production departments' level of competitiveness. In order to satisfy the demands of the worldwide target audience, it is getting harder for the departments to maintain a seamless supply chain structure. The coronavirus-infected individuals are under medical care or home isolation and require periodic monitoring. Utilizing these tools or management systems, they must share their health issues and the best and most accurate information they are aware of for the purpose of receiving better and more effective care.

 

However, in the current projected period, this management software will become more competitive and technologically advanced. Similar initiatives are receiving backing from the government. Additionally, several of them are funding global initiatives of a similar nature that will cause the industry to expand across numerous global areas.

Additionally, the leading market players are open to growth by product modification, invention, creation, mergers and acquisitions, and establishment, followed by market launches for the target audience that is dispersed throughout a number of regions worldwide.

 

By Component

The market for healthcare claims management was dominated by the software sector. Growing software technology improvements and an increase in software usage for accurate and efficient claim processing are the drivers driving the component segment.

 

By Type

Both integrated and standalone solutions are available in the global market for healthcare claims management. The market segment for integrated solutions is predicted to have the greatest CAGR over the forecast period. The rapid expansion of this market can be ascribed to the rising demand for integrated solutions, which are crucial to raising process effectiveness and lowering costs.

 

By Delivery Mode

On-premise and cloud-based systems make up the two segments of the healthcare claims management market. The sector based on the cloud is anticipated to experience the largest CAGR growth during the projection period. This segment's rapid growth can be explained by the substantially reduced capital expenditures and operating costs, as well as higher scalability, flexibility, and affordability.

 

By End User

Healthcare payers and providers make up the two segments of the global market.

 

COMPETITIVE LANDSCAPE

Some of the major key players are as follows: Oracle Corporation, Allscripts Healthcare Solutions, Inc., eClinicalWorks LLC, Athenahealth Inc., GE Healthcare, COGNIZANT TECHNOLOGY SOLUTIONS CORPORATION, Optum, Inc, Quest Diagnostics, The SSI Groups Inc., McKesson Corporation, and other players.

 

MARKET SEGMENTS:

By Component

  • Software

  • Services

 

By Type

  • Integrated Solutions

  • Standalone Solutions

 

By Delivery Mode

  • On-premise

  • Cloud-based

 

By End User

  • Healthcare Payers

  • Healthcare Providers

Healthcare Claims Management Market

REGIONAL ANALYSIS

Europe, Asia, and the Rest of the World, respectively. The market for these is anticipated to be dominated by the North American region. The significant market share of North America is explained by the region's high and expanding HCIT investments as well as the existence of legislative requirements that encourage the adoption of healthcare claims management solutions. Additionally, the US has a number of significant international competitors, which has made it a hub for innovation in the healthcare claims management solutions industry.

The region with the highest CAGR is anticipated to be Asia. High growth is expected to occur in Asia during the forecast period due to a number of factors, including investments in modernizing the healthcare infrastructure in China, growing adoption of healthcare IT solutions, initiatives to improve the quality of healthcare delivery in Japan, and the rapid expansion of the healthcare sector in India.

 

REGIONAL COVERAGE:

  • North America

    • USA

    • Canada

    • Mexico

  • Europe

    • Germany

    • UK

    • France

    • Italy

    • Spain

    • The Netherlands

    • Rest of Europe

  • Asia-Pacific

    • Japan

    • south Korea

    • China

    • India

    • Australia

    • Rest of Asia-Pacific

  • The Middle East & Africa

    • Israel

    • UAE

    • South Africa

    • Rest of Middle East & Africa

  • Latin America

    • Brazil

    • Argentina

    • Rest of Latin America

Healthcare Claims Management Market Report Scope
Report Attributes Details
Market Size in 2021 US$ 12.77 Billion
Market Size by 2028 US$ 19.08 Billion
CAGR CAGR of 5.9% From 2022 to 2028
Base Year 2021
Forecast Period 2022-2028
Historical Data 2017-2020
Report Scope & Coverage Market Size, Segments Analysis, Competitive  Landscape, Regional Analysis, DROC & SWOT Analysis, Forecast Outlook
Key Segments • By Component (Software, Services)
• By Type (Integrated Solutions, Standalone Solutions)
• By Delivery Mode (On-premise, Cloud-based)
• By End User (Healthcare Payers, Healthcare Providers)
Regional Analysis/Coverage North America (USA, Canada, Mexico), Europe
(Germany, UK, France, Italy, Spain, Netherlands,
Rest of Europe), Asia-Pacific (Japan, South Korea,
China, India, Australia, Rest of Asia-Pacific), The
Middle East & Africa (Israel, UAE, South Africa,
Rest of Middle East & Africa), Latin America (Brazil, Argentina, Rest of Latin America)
Company Profiles Oracle Corporation, Allscripts Healthcare Solutions, Inc., eClinicalWorks LLC, Athenahealth Inc., GE Healthcare, COGNIZANT TECHNOLOGY SOLUTIONS CORPORATION, Optum, Inc, Quest Diagnostics, The SSI Groups Inc., McKesson Corporation, and other players.
Key Drivers • Patient Volumes Are Growing
• Health Insurance Market is Growing
• Enhancements to Process in Healthcare Organizations
Restraints • Exorbitant Deployment Costs


Frequently Asked Questions (FAQ) :

 The market segment for integrated solutions is predicted to have the greatest CAGR over the forecast period.

The market for these is anticipated to be dominated by the North American region.

 Healthcare Claims Management Market is divided into three segments By Component, By Type, By Delivery Mode, and By End User

 Exorbitant Deployment Costs are the restraints of Healthcare Claims Management Market

Healthcare Claims Management market is expected grow at a CAGR of 5.9% over the forecast period 2022-2028. 


Table of Content 

 

1. Introduction

1.1 Market Definition

1.2 Scope

1.3 Research Assumptions

 

2. Research Methodology

 

3. Market Dynamics

3.1 Drivers

3.2 Restraints

3.3 Opportunities

3.4 Challenges

 

4. Impact Analysis

4.1 COVID 19 Impact Analysis

4.2 Impact of Ukraine ware

 

5. Value Chain Analysis

 

6. Porter’s 5 forces model

 

7.  PEST Analysis

  

8. Healthcare Claims Management Market Segmentation, By Component

8.1 Software

8.2 Services

 

9. Healthcare Claims Management Market Segmentation, By Type

9.1 Integrated Solutions

9.2 Standalone Solutions

 

10. Healthcare Claims Management Market Segmentation, By Delivery Mode

10.1 On-premise

10.2 Cloud-based

 

11. Healthcare Claims Management Market Segmentation, By End User

11.1 Healthcare Payers

11.2 Healthcare Providers

 

12. Regional Analysis

12.1 Introduction

12.2 North America

12.2.1 USA

12.2.2 Canada

12.2.3 Mexico

12.3 Europe

12.3.1 Germany

12.3.2 UK

12.3.3 France

12.3.4 Italy

12.3.5 Spain

12.3.6 The Netherlands

12.3.7 Rest of Europe

12.4 Asia-Pacific

12.4.1 Japan

12.4.2 South Korea

12.4.3 China

12.4.4 India

12.4.5 Australia

12.4.6 Rest of Asia-Pacific

12.5 The Middle East & Africa

12.5.1 Israel

12.5.2 UAE

12.5.3 South Africa

12.5.4 Rest

12.6 Latin America

12.6.1 Brazil

12.6.2 Argentina

12.6.3 Rest of Latin America

 

13.Company Profiles

13.1 Allscripts Healthcare Solutions, Inc.,

            13.1.1 Financial

13.1.2 Products/ Services Offered

13.1.3 SWOT Analysis

13.1.4 The SNS view

13.2 eClinicalWorks LLC

13.3 Athenahealth Inc.

13.4 GE Healthcare

13.5 Cognizant Technology Solutions corporation

13.6 Optum, Inc

13.7 Quest Diagnostics

13.8 The SSI Groups Inc.

13.9 McKesson Corporation

13.10 Oracle Corporation

 

14.Competitive Landscape

14.1 Competitive Benchmark

14.2 Market Share analysis

14.3 Recent Developments

 

15.Conclusion

 

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Step 1: Secondary Research:

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Secondary Research

Step 2: Primary Research

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