Healthcare Claims Management Market Size, Share and Analysis by Component (Software and Services), By Delivery Mode (On-premise and Cloud Based), By End-User (Healthcare Providers and Payers), and Regional Forecast, 2024-2032

Healthcare claims management refers to the multitasking process of organizing, billing, filing, processing, and updating medical claims related to patient diagnosis, medication, and treatment. Health insurance claims management software helps manage medical claims and reimbursement processes in the health insurance industry. The market is driven due to an increased focus on providing high-quality healthcare services to the general population and the rising adoption of technology-related services. Along with this new product, launches by the key players in the market are driving market growth. For instance, in February 2022, Five Sigma collaborated with Medlogix to integrate the platforms, which help insurers to improve decision-making, maximize efficiencies, increase ROI and enhance outcomes in medical claims management.

The rise in the automation trend in the healthcare industry, technological innovations, and the rise in R&D expenditure are responsible factors for the growth of the market. In August 2022, Anomaly Insights, Inc. launched software that uses artificial intelligence to predict potential insurance claims denials.

 Impact of COVID-19 on the market

The COVID-19 pandemic is expected to boost the growth of the global healthcare claims management market during the forecast period due to an increase in claims due to the rising number of COVID-19 patient admissions and visits in hospitals and clinics. According to an article published in March 2022, healthcare claims have increased by 3.5% in 2021 as compared to the previous year.

Key Insights 

The report will cover the following key insights:

• Number of insured population-2021.


• Prevalence of oral disorders- for key countries/ regions.


• New product launches, by key players.


• Impact of COVID-19 on the market.


• Key Mergers, Acquisitions, and Partnerships.

Analysis by Component:

The software segment is expected to drive the market due to the rising adoption of the software by providers and payers to manage the claims data, as the amount of data is huge. The demand for the software is rising to streamline the medical claims process and to improve the patient payment lifecycle. Moreover, the key players are introducing new software to manage medical claims.

• In October 2020, Civica launched Civica Ensure, a cloud-based software to manage policy, claiming, billing, and reporting.

Analysis by Delivery mode

The cloud-based segment is expected to drive the market due to the increased adoption of secure cloud infrastructure and increased use of updated software and applications to meet the current evolving needs of the medical billing industry. Moreover, the launch of innovative products to meet increasing end-user demand is expected to drive the growth of this segment.

• In October 2021, Blue Shield of California collaborated with Google Cloud to automate the claims management process in real-time.  

Analysis by region

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The North American region is the largest market for the medical claims management industry. Factors such as the aging population, increasing adoption of technology by healthcare payers, and the presence of large corporations are expected to drive growth. Moreover, increasing numbers of health insurance subscribers, favorable personal mandates imposed by the Affordable Care Act (ACA), and the existence of favorable reimbursement frameworks are some of the factors responsible for significant regional market share.

• In March 2022, nThrive, Inc., launched an end-to-end revenue management platform at HIMSS 2022 with covers a claims management module.

Key Players Covered

The report will include the profiles of key players such as Accenture plc, Allscripts Healthcare Solutions, Inc., Athenahealth Inc., Oracle Corporation (Cerner Corporation), Genpact Limited, Conduent Inc., IBM Corporation, McKesson Corporation, Optum, Inc. and others.

Segmentation

Key Industry Developments

• In November 2019, Sentry Data Systems, Inc., launched a pharmacy claims management solution to help reduce denials and improve claims processing.


• In September 2020, One Team Health launched the PLEXIS Canopy Care Management solution in service of 20,000 insured members to expand its services in healthcare claims management.


• In April 2021, Integrated Health Information Systems collaborated with trade associations General Insurance Association Singapore and Life Insurance Association Singapore to create an integrated platform that enables faster processing of hospitalization claims.