Healthcare Claims Management Market Size, Share, Trends, COVID-19 Impact and Growth Analysis Report - Industry Forecast (2021 to 2026)

Healthcare Claims Management Market Size Analysis (2021-2026)

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.

 

MARKET DRIVERS

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.

 

MARKET RESTRAINTS

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.

 

HEALTHCARE CLAIMS MANAGEMENT MARKET REPORT COVERAGE

REPORT METRIC

DETAILS

Market Size Available

2020 – 2026

Base Year

2020

Forecast Period

2021 – 2026

Segments Covered

By Component, Type, Delivery Mode, End-User, and Region

Regions Covered

North America, APAC, Europe, LATAM, MEA

 

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Segmentation Analysis

The global Healthcare Claims Management Market has been segmented and sub-segmented based on the following categories.

 

Healthcare Claims Management Market - By Component

  • Software
  • Services

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.

 

Healthcare Claims Management Market - By Type

  • Integrated Solutions
  • Standalone Solutions

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.

 

Healthcare Claims Management Market - By Delivery Mode

  • On-premise
  • Cloud-based

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.

 

Healthcare Claims Management Market - By End-User

  • Healthcare Payers
  • Healthcare Providers
  • Other End Users

The healthcare providers' end-user segment is expected to grow at the highest CAGR rate during the forecast period.

 

Healthcare Claims Management Market - By Region

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:

  1. DST Systems (US)
  2. Cognizant Technology Solutions (US)
  3. Allscripts Healthcare Solutions, Inc. (US)
  4. Context 4 Healthcare (US)
  5. Health Solutions Plus (US)
  6. GE Healthcare (US)
  7. RAM Technologies (US)
  8. Quest Diagnostics (US)
  9. The SSI Group (US)
  10. PLEXIS Healthcare Systems (US)
  11. GeBBS Healthcare Solutions (US)

 

Notable Happenings in the global Healthcare Claims Management Market

  • On September 16, 2021, McKesson Corporation disclosed Mckesson's Rapid Returns Solutions for Health Systems. The newly launched solution helps the hospitals and health systems hike the amount of credit received for returned pharmaceuticals and OTC products.
  • On June 07, 2021, United HealthCare has made changes in the emergency department claims evaluation protocols. The payer provides insurance coverage for the emergency department only if they are esteemed to be emergent, in an attempt to cut back on healthcare expenses.
  • On February 23, 2021, Conifer Health Solutions announced the extension of its relationship with LCMC Health to provide physician accounts receivable (AR) management and small-balance support, and COVID-19 vaccine scheduling services.

 

COVID-19 Impact on 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

1.2. Assumptions

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

6.1. Software

6.2. Services

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

8.1. On-Premise

8.2. Cloud Based

Chapter 9. Healthcare Claims Management Market  – By End-User

8.1. Healthcare Payers

8.2. Healthcare Providers

8.3. Others

Chapter 10. Healthcare Claims Management Market  , By Geography – Market Size, Forecast, Trends & Insights

10.1. North America

                10.1.1. U.S.A

                10.1.2. Canada

                10.1.3. Mexico

10.2. Europe

                10.2.1. Italy

                10.2.2. Spain

                10.2.3. Russia

                10.2.4. Germany

                10.2.5. UK             

                10.2.6. France

                10.2.7. Rest of Europe

10.3. Asia Pacific

                10.3.1. Japan

                10.3.2. South Korea

                10.3.3. China

                10.3.4. India

                10.3.5. Australia & New Zealand

                10.3.6. Rest of Asia-Pacific

10.4. Rest of the World

                10.4.1. Middle East

                10.4.2. Africa

                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.​

Data Collection 

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. ​

Data Fusion

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.

Data Analysis

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.

Verification ​

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.​

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