The global healthcare claims management market size was worth USD 10.26 billion in 2020 and is expected to grow with a CAGR of 5.8% to reach USD 13.95 billion by 2026.
Healthcare claims management is a procedure that includes different tasks like billing, organizations, filling, processing, and updating medical claims associated with the diagnosis, treatment, and medication of patients.
Healthcare claims management is also defined as the software which manages medical claims and reimbursement policies allowing healthcare providers to amend their revenues by appropriate claim management.
The rise of inventive technologies and treatments and quick increase in the occurrence of chronic diseases foster the healthcare claims management market growth. Elderly adults are more prone to increasing chronic diseases surge the market growth.
The governments across various countries are coming forward with innovative initiatives supporting health insurance markets, and a surge in healthcare quality services fuels the market growth globally.
Moreover, escalating private health insurance markets with developments of computerized medical billing and management upsurge the healthcare claims management market growth throughout the timeline period. The insurance companies are primarily focusing on advancing healthcare quality services with the growth in the number of medical claims flourish the market growth. The number of patients’ volume recovering under medical insurance is surging with the increase in premium costs. These factors will accentuate the market growth of healthcare claims management.
However, factors like the absence of talented and experienced IT professionals diminish the healthcare claims management market growth. Moreover, rising cybercrime cases and mounting issues regarding patient data safety and security hinder the market growth.
Market Size Available
2020 – 2026
2021 – 2026
By Component, Type, Delivery Mode, End-User, and Region
North America, APAC, Europe, LATAM, MEA
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The global Healthcare Claims Management Market has been segmented and sub-segmented based on the following categories.
By component, the software segment dominated the healthcare claims management market in 2015. The factors propelling the component segment are increasing advancements in technology in software and the use of the software is rising for appropriate and swift processing claims.
Based on the type, the integrated solutions segment holds the largest share in the market. The segment also grows with the highest CAGR growth rate during the historical period. The segment growth attributes as the demand for integrated solutions is surging. The segment plays a vital role in developing efficacy and obstructing price.
The cloud-based delivery mode segment is to dominate the healthcare claims management market. The segment is used to decrease the time required for claims processing and also control administrative prices. Moreover, it allows real-time claim processing with no time for batch processes.
The healthcare providers' end-user segment is expected to grow at the highest CAGR rate during the forecast period.
Regionally, the largest share in the healthcare claims management market is backed by North America and is expected to retain its dominance throughout the forecast period. Increasing investments in HCIT, and the presence of regulatory necessity supporting the execution of healthcare claims management solutions. Major key players are based in the U.S. as the United States has become the hub for inventing the healthcare claims management solutions market.
Europe is the second-largest region growing with a considerable share in the healthcare claims management market. Some of the top insurance claims management software in Europe include Nuxeo Platform, E-Claim.com, BrokerEdge, Innoveo Skye, and many more. Increasing patient volume with increasing medical insurance policies and growth in adoption for EHRs and e-prescribing services nourish the region's growth.
However, Asia-Pacific is projected to grow with the highest CAGR growth during the timeline period. Factors like growing investments to update the healthcare infrastructure accelerate the healthcare claims management market. China is said to lead the market with the highest share. In China, the adoption of healthcare IT solutions is rising which fuels the market growth in China. The healthcare sector in India has seen quick growth and measures to accumulate the quality of healthcare delivery in Japan.
Latin America and the Middle East and African regions are at their developing stages. The governments of these regions are to provide healthcare services and insurance coverage policies that motivate the government to progress technology and mount the market growth.
Top key players operating in the global Healthcare Claims Management Market
Cerner Corporation (US), McKesson Corporation (US), athenahealth (US), eClinicalWorks (US), Optum, Inc, (US), Conifer Health Solutions (US), and nThrive (US) are the key players in the healthcare claims management market.
Other key market players operating in the global healthcare claims management market are:
Notable Happenings in the global Healthcare Claims Management Market
The novel coronavirus (COVID-19) has positively impacted the healthcare claims management market. The COVID-19 cases are surging day by day. Patients who got admitted to the hospitals have insurance claims and reimbursement policies. Most of them are focusing on insurance companies and the insurance companies tie up with the hospitals for claiming medical bills.
Chapter 1. Healthcare Claims Management Market – Scope & Methodology
1.1. Market Segmentation
1.3. Research Methodology
1.4. Primary Sources
1.5. Secondary Sources
Chapter 2. Healthcare Claims Management Market – Executive Summary
2.1. Market Size & Forecast – (2021 – 2026) ($M/$Bn)
2.2. Key Trends & Insights
2.3. COVID-19 Impact Analysis
2.3.1. Impact during 2021 - 2026
2.3.2. Impact on Supply – Demand
2.3.3. Impact on Production Cost
2.3.4. Impact on Supply Chain
Chapter 3. Healthcare Claims Management Market – Competition Scenario
3.1. Market Share Analysis
3.2. Product Benchmarking
3.3. Competitive Strategy & Development Scenario
3.4. Competitive Pricing Analysis
3.5. Supplier - Distributor Analysis
Chapter 4. Healthcare Claims Management Market Entry Scenario
4.1. Case Studies – Start-up/Thriving Companies
4.2. Regulatory Scenario - By Region
4.3 Customer Analysis
4.4. Porters Five Force Model
4.4.1. Bargaining Power of Suppliers
4.4.2. Bargaining Powers of Customers
4.4.3. Threat of New Entrants
4.4.4. Rivalry among Existing Players
4.4.5. Threat of Substitutes
Chapter 5. Healthcare Claims Management Market - Landscape
5.1. Value Chain Analysis – Key Stakeholders Impact Analysis
5.2. Market Drivers
5.3. Market Restraints/Challenges
5.4. Market Opportunities
Chapter 6. Healthcare Claims Management Market – By Component
Chapter 7. Healthcare Claims Management Market – By Type
7.1. Integrated Solutions
7.2. Standalone Solutions
Chapter 8. Healthcare Claims Management Market – By Delivery Mode
8.2. Cloud Based
Chapter 9. Healthcare Claims Management Market – By End-User
8.1. Healthcare Payers
8.2. Healthcare Providers
Chapter 10. Healthcare Claims Management Market , By Geography – Market Size, Forecast, Trends & Insights
10.1. North America
10.2.7. Rest of Europe
10.3. Asia Pacific
10.3.2. South Korea
10.3.5. Australia & New Zealand
10.3.6. Rest of Asia-Pacific
10.4. Rest of the World
10.4.1. Middle East
10.4.3. South America
Chapter 11. Healthcare Claims Management Market – Company Profiles – (Overview, Product Portfolio, Financials, Developments)
11.1. Company 1
11.2. Company 2
11.3. Company 3
11.4. Company 4
11.5. Company 5
11.6. Company 6
11.7. Company 7
11.8. Company 8
11.9. Company 9
11.10. Company 10
Primary & Secondary Sources to Collect & Validate Data
Utilization of Both Top Down & Bottom Up Approach
Holistic Research Methodology
Scope & Introductory Research
In the initial stage of research, the scope for market is defined. In order to better understanding of the market, secondary focus is on different segmentations of the market. Preliminary research involves identifying key data points related to the market under consideration to estimate the market sizes to the best extent.
Based on the scope of the market and the key data points, a number of secondary sources are considered. This data collection stage consists of a team of analysts who gather data from various secondary resources, accessing proprietary databases and primary research by reaching out to key market participants and opinion leaders.
At this stage, collected data using several sources is arranged in structured format. The sources include industry participants, in-house models, key opinion leaders in the market ecosystem and databases. Historical data trends are established at this point, and compared to the current scenario. Based on the macro- and micro-factor prevailing in various geographies, proprietary data models are used to analyze key market countries. Key players in this market are listed based on their capabilities in revenue, sales, and development. The study also involves the identification of companies in the category of 'new entrants' and their potential effects on the market.
At this stage, the analyst team moves on to understand how the market has changed over the years. The total size of the market is gathered after an study of different business segments and end-users is done. An impact research is also done to see what factors will/may influence the market in the years ahead. The effect of various variables on the industry is often taken into account when forecasting market sizes.
Data verification is conducted at all research levels, however this stage is dedicated to more rigorous checking of the data points. At this stage, the estimated data is triangulated with company revenues and checked with industry experts including several senior executives and key opinion leaders in the market. The data is then summarized, and the findings are derived from the same for the report.
Quality Assurance & Report Preparation
Holistic research methodology is followed with combination of Top Down and Bottom Up approach to undertake the estimation and forecasting task in order to ensure quality of data. At this stage of the research process, a dedicated QA team checks the data and approves after several predefined checks. Each section is checked and questioned to make the report accurate and reliable. In case of discrepancy, a team of analysts reviews the issue, and the whole process is repeated again. That significantly improves the report's quality. After approval, all the parts of the report are brought together and is formatted by highly trained team thus making it ready to dispatch.