Healthcare EDI Market Report Scope & Overview:

The Healthcare EDI Market Size was valued at USD 4.82 billion in 2023, and is expected to reach USD 10.12 billion by 2031, and grow at a CAGR of 9.7% over the forecast period 2024-2031.

The programmed development of information between a specialist co-op and a payer is known as electronic data interchange (EDI). It gives advantages to suppliers, for example, quicker data handling, less managerial weight, and the evasion of guarantee handling delays. Payers and health-care providers can use EDI to send and receive data more quickly and at a lower cost. EDI helps with the exchange of patient health information, insurance processing, and prescription information exchanges. As a result, EDI is critical for data administration in a range of medical sectors, including regulatory affairs, clinical testing, and data management for insurance companies.

Healthcare EDI Market Revenue Analysis

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When data is transmitted electronically, there are fewer chances of human error. It aids in the reduction of manual systems via medical electronic data interchange, hence minimising manual errors. As a result, the healthcare industry is rapidly accepting EDI services in order to cut paperwork and speed up financial issues. It eliminates manual errors by reducing manual systems with medical electronic data interchange. Demand for Healthcare EDI services technology is likely to rise in the next years, driven by the growing requirement for supply chain management and claims administration. The healthcare EDI has a wide range of applications, including insurance, dental and medical patient database administration, regulatory, reimbursement data management, and clinical trials, to name a few.



  • Transaction-process-friendly regulations

  • The need to reduce healthcare spending is becoming more pressing.

  • HCIT is backed by the government.


  • Patients and EDI users alike are concerned about data security.

  • High cost of EDI software implementation


  • Outsourcing EDI services has become more common.

  • ICD-11 guidelines are now in use.


  • Within the healthcare market, there is integration between several HCIT solutions.

  • restrictions and prerequisites


There is a continuing slowdown in the healthcare business as a result of the global epidemic of COVID-19 and the imposed lockout. COVID-19 wreaked havoc on major world economies, especially the healthcare sector, in addition to communities. The approach of major players is still being adjusted to the quickly changing scenario. The medical services business is supposed to be affected essentially by COVID-19 over the long haul. Until the emergency dies down, nations and significant players would need to make huge medical services changes.

Technological advancements, cost containment, and expanded access will all be part of healthcare reform in the near future. In the current pandemic, computerized wellbeing and telemedicine have become the dominant focal point. The need of far-off finding, care, and counsel was focused on again at COVID-19. Regulatory and behavioural constraints have hindered market growth in recent years. Patients with intermediate social distancing were also required to consult online as part of the social distancing treatments. COVID-19 is predicted to have a substantial influence on the Healthcare EDI Market due to these considerations.

Value chain Analysis

Web-based and cloud-based services are the most common ways for healthcare organisations to exchange electronic data. Conducting Electronic Data Interchange operations via an internet browser is part of the Web-based sector. The seller or trading partners will fill out paper-based paperwork on an internet browser. This data is transferred automatically via secure internet protocols in the form of an EDI message. In most cases, FTPS and HTTPS are used. For businesses with trading partners from a variety of (different) countries, web-based solutions are extremely helpful.

Because of the greater flexibility that mobile-based solutions provide, they are widely used. The key benefit of using the software solution is the supply chain control that the mobile-based system provides. For example, incidents such as making an invoice with a simple barcode scan and delivering it to the customer are propelling the increase of the Healthcare electronic data interchange industry.

On the other hand, cloud-based solutions provide reliable data mobility and flexibility, as well as faster ride, and are thought to be more profitable for companies that process B2B data. Accuracy of record keeping, as well as timely processing of insurance claims, payment information, and other IT-related information. Prior to HIPAA, the healthcare industry had to deal with more than 400 medical forms, which took time and effort to manage by hand. These are the main drivers of the Healthcare Electronic Data Interchange market expansion.

By Component Type

Due to reasons such as rising claims volume, increasing complexity and size of EDI systems, and the need for expensive training programmes, the services segment is likely to rise at a higher rate in this market. Similarly, a growing tendency of outsourcing activities including revenue cycle management, claims handling and administration, and partner management services is likely to drive the services industry forward.

By Transaction Type

The healthcare supply chain and claims management segments of the healthcare EDI market are separated. During the forecast period, the claims management sector is estimated to account for the highest proportion of the healthcare EDI market. The increased usage of EDI services by healthcare providers and payers, as well as the necessity to meet regulatory requirements, can be attributable to this segment's substantial share.

By Delivery Mode

The mobile EDI segment is predicted to develop at the fastest rate among the delivery mode segments over the projection period. The technical advancements in the healthcare business, as well as the increased acceptance of mobile solutions by healthcare providers, are contributing to this segment's rapid rise.

By End-User

The health care EDI is divided into four categories: providers, payers, medical equipment and pharmaceutical firms, and pharmacies. Due to the growing number of independent insurance players in the market, the healthcare sector is predicting that it will grow at a much faster CAGR at the time of forecasting.


By Component Type

  • Services

  • Solutions

By Transaction Type

  • Claims Management

  • Healthcare Supply Chain

By Delivery Mode

  • Web & Cloud-based EDI


  • Point-to-Point EDI

  • Mobile EDI

By End-User

  • Healthcare Providers

  • Healthcare Payers

  • Medical Device & Pharmaceutical Industries

  • Pharmacies


Because of the higher adoption of Healthcare Information Technology (HCIT) in North America, the region dominated the market. Due to rising demand for electronic data exchange services/solutions among pharmaceutical companies and medical device makers to combat growing competitiveness, pricing pressure, and decreased profit margins, Europe is likely to hold a significant market share throughout the projection period.

The Asia Pacific region's market is predicted to be driven by regulatory reforms, economic expansion, and the increasing IT industry. Furthermore, increased patient volume, the requirement to manage a huge volume of patient data, and the deployment of HCIT programmes in India, Japan, and Australia are projected to aid the vertical's growth.

Healthcare EDI Market By Region

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  • 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


Some of the major key players of Healthcare EDI Market are as follows: OSPOptum, Inc., Cleo, McKesson Corporation, Cerner Corporation, NXGN Management, LLC, Data Trans Solutions, 1 EDI Source (Epicor Software Corporation), SSI Group LLC, Effective Data and Other Players.

Cleo-Company Financial Analysis

Company Landscape Analysis

Healthcare EDI Market Report Scope:
Report Attributes Details
Market Size in 2023 US$ 4.82 Billion
Market Size by 2031 US$ 10.12 Billion
CAGR CAGR of 9.7% From 2024 to 2031
Base Year 2023
Forecast Period 2024-2031
Historical Data 2020-2022
Report Scope & Coverage Market Size, Segments Analysis, Competitive  Landscape, Regional Analysis, DROC & SWOT Analysis, Forecast Outlook
Key Segments • By Component Type (Services, Solutions)
• By Transaction Type (Claims Management, Healthcare Supply Chain)
• By Delivery Mode (Web & Cloud-based EDI, EDI VAN, Point-to-Point EDI, Mobile EDI)
• By End-User (Healthcare Providers, Healthcare Payers, Medical Device & Pharmaceutical Industries, Pharmacies)
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 OSP, Optum, Inc., Cleo, McKesson Corporation, Cerner Corporation, NXGN Management, LLC, Data Trans Solutions, 1 EDI Source (Epicor Software Corporation), SSI Group LLC, and Effective Data.
DRIVERS • Transaction-process-friendly regulations
• The need to reduce healthcare spending is becoming more pressing.
• HCIT is backed by the government.
RESTRAINTS • Patients and EDI users alike are concerned about data security.
• High cost of EDI software implementation

Frequently Asked Questions

Ans: The expected value of the Healthcare EDI Market in 2031 is USD 10.12 billion.

Ans: The CAGR of the Healthcare EDI Market is 9.7% over the forecast period 2024-2031.

  • Transaction-process-friendly regulations

  • The need to reduce healthcare spending is becoming more pressing.

  • HCIT is backed by the government.

  • Within the healthcare market, there is integration between several HCIT solutions.

  • restrictions and prerequisites

Ans: The prominent players in the market are OSP, Optum, Inc., Cleo, McKesson Corporation, Cerner Corporation, NXGN Management, LLC, Data Trans Solutions, 1 EDI Source (Epicor Software Corporation), SSI Group LLC, and Effective Data, and others in the final report.

Table of Contents

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- Russia war

4.3 Impact of ongoing Recession

4.3.1 Introduction

4.3.2 Impact on major economies US Canada Germany France United Kingdom China Japan South Korea Rest of the World

5. Value Chain Analysis

6. Porter’s 5 forces model

7.  PEST Analysis


8. Healthcare EDI Market Segmentation, By Component Type

8.1 Services

8.2 Solutions

9. Healthcare EDI Market Segmentation, By Transaction Type

9.1 Claims Management

9.2 Healthcare Supply Chain

10. Healthcare EDI Market Segmentation, By Delivery Mode

10.1 Web & Cloud-based EDI

10.2 EDI VAN

10.3 Point-to-Point EDI

10.4 Mobile EDI

11. Healthcare EDI Market Segmentation, By End-User

11.1 Healthcare Providers

11.2 Healthcare Payers

11.3 Medical Device & Pharmaceutical Industries

11.4 Pharmacies

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 OSP

13.1.1 Financial

13.1.2 Products/ Services Offered

13.1.3 SWOT Analysis

13.1.4 The SNS view

13.2 Optum, Inc.

13.3 Cleo

13.4 McKesson Corporation

13.5 Cerner Corporation

13.6 NXGN Management, LLC

13.7 Data Trans Solutions

13.8 1 EDI Source (Epicor Software Corporation)

13.9 SSI Group LLC

13.10 Effective Data.

14. Competitive Landscape

14.1 Competitive Benchmark

14.2 Market Share Analysis

14.3 Recent Developments

15. Conclusion

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The 5 steps process:

Step 1: Secondary Research:

Secondary Research or Desk Research is as the name suggests is a research process wherein, we collect data through the readily available information. In this process we use various paid and unpaid databases which our team has access to and gather data through the same. This includes examining of listed companies’ annual reports, Journals, SEC filling etc. Apart from this our team has access to various associations across the globe across different industries. Lastly, we have exchange relationships with various university as well as individual libraries.

Secondary Research

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We at SNS Insider have divided Primary Research into 2 parts.

Part 1 wherein we interview the KOLs of major players as well as the upcoming ones across various geographic regions. This allows us to have their view over the market scenario and acts as an important tool to come closer to the accurate market numbers. As many as 45 paid and unpaid primary interviews are taken from both the demand and supply side of the industry to make sure we land at an accurate judgement and analysis of the market.

This step involves the triangulation of data wherein our team analyses the interview transcripts, online survey responses and observation of on filed participants. The below mentioned chart should give a better understanding of the part 1 of the primary interview.

Primary Research

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Data Bank Validation

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