Healthcare Claims Management Market Top Players, Segments, Cost Structure, Demand, Sales | 2030 Forecast

 Healthcare Claims Management Market Growth & Trends 

The global healthcare claims management market size is expected to reach USD 136.67 billion by 2030, according to a new report by Grand View Research, Inc. It is expected to expand at a CAGR of 23.4% from 2022 to 2030. The rising complexity of claims administration and the medical billing process is one of the most immediate concerns confronting health insurance companies and other private payers. The capacity to digitize every stage of the claims process, implying process improvement, from data entry to claims management and billing processing, holds enormous promise for increasing medical billing and claims management efficiency and accuracy. When done correctly, the result may be cheaper expenses and a better customer experience. Thus, improvements to the overall healthcare organization’s process are expected to propel industry growth. 

Furthermore, the growing importance of denial management is expected to further boost industry growth. According to a Kaiser Family Foundation recent analysis, around 17% of in-network claims were refused across HealthCare.gov issuers in 2019 and approximately 14% were denied in 2018. Specific issuer rates differed greatly from these averages. As a result, financial strategists who are truly focused on the transition from volume to value undervalue it. This is a mistake since dealing with rejections is as important now as it was decades ago. 

The global COVID-19 pandemic has had a mixed impact on the overall market. Furthermore, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was designed in developed countries such as the U.S. to provide healthcare resources required to combat COVID-19. The CARES Act incorporated medical billing rules, which increased claim denials and their management. This will further boost the overall market for medical billing and healthcare claims management. 

Despite the expected rise in the market, there have been rising concerns in terms of data privacy. For instance, modern technologies such as cloud, mobile, and next-generation databases are increasingly being used to manage, store, and retrieve such claims data as technology advances. These elements have conspired to form healthcare data security an ongoing concern for the overall healthcare industry. To guarantee that patients have the data protection they need and deserve, rules and regulations governing healthcare data are always evolving. 

Due to the clear nascent nature of technology innovation in the medical billing and claims processing market, the share is widely distributed across various competitors. This is bolstered by the fact that a large number of businesses have joined the market due to the minimum capital requirements for establishing and maintaining technological infrastructure. However, there has been a reduced risk of entry to some extent due to the complexity in the healthcare medical billing and claims processing market dynamics. 

Larger, established players and well-known players have a credibility advantage, which reduces the threat of entry from smaller, less established players with minimal IT experience in healthcare. However, due to the expanding number of advanced solution providers, such as CareCloud, Inc., and AdvancedMD, who are increasingly focusing on lowering claim denial rates and improving the medical billing rates, the industry is set to experience a higher new entrant rate. 

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Healthcare Claims Management Market Report Highlights 

• Providers actively wanted methods to enhance their claim management and medical billing systems. As a result, one strategy is to create an integrated billing and claims processing system, which offers several advantages. As a result, integrated solutions accounted for a dominant revenue share of more than 70.0%
• By component, the software segment accounted for the largest revenue share of more than 65.0% in 2021. It is expected to maintain its dominance throughout the forecast period
• The healthcare industry has been revolutionized by overall digitization, which has improved patient treatment guidance systems and software technologies that have provided simple access to healthcare data through cost-effective automated billing and claims processing systems. Medical billing and claims processing software have several advantages, including more accurate bills, fewer administrative errors, fewer insurance claim denials, invoice tracking, and speedier payments, which boosts efficiency and accuracy even more
• The web-based and cloud-based deployment mode segments have a strong competitive presence in the market. They together accounted for more than 85.0% share of the overall revenue in 2021. Furthermore, regardless of the industry, overall cloud billing services assist organizations in saving money while still offering excellent customer service. According to a Flexera study from 2021, 93% of organizations are using cloud-based technology, with 73% seeking to optimize their present cloud utilization for cost savings. As a result, the cloud-based billing industry's overall growth is being supported by a growing need for cheaper capital and operating costs
• The healthcare providers' end-use segment is anticipated to rise moderately over the forecast period, with growth aided by the adoption of rigorous regulatory rules in various countries, such as the U.S. Healthcare payers are expected to expand rapidly during the forecast period, supported by the implementation of stringent regulatory requirements, an in-house lack of experienced individuals for claims processing, and growing healthcare costs and related frauds
• North America accounted for the largest revenue share of over 35.0% in 2021 owing to an increase in patient load and healthcare coverage, adoption of EHRs and e-prescribing services, growing government spending, and improving healthcare infrastructure
• The Asia Pacific market is likely to witness the fastest growth over the forecast period mainly owing to a quick expansion of the healthcare business, government attempts to improve the quality of healthcare delivery systems and the adoption of technological advancements such as healthcare IT systems
• Key players also contribute to the industry growth by entering partnerships, mergers, and acquisitions, and launching new products. For instance, in October 2021, The SSI Group developed a strategic alliance with RCxRules to provide updated automated billing solutions for healthcare organizations' population health and revenue cycle operations, resulting in revenue growth as the strategic partnership grows

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Healthcare Claims Management Market Segmentation

Grand View Research has segmented the global healthcare claims management market by product, component, solution type, deployment mode, end-use, and region:

Healthcare Claims Management Product Outlook (Revenue, USD Million, 2017 - 2030)

• Medical Billing
  • Professional
  • Institutional
• Claims Processing

Healthcare Claims Management Component Outlook (Revenue, USD Million, 2017 - 2030)

• Software
• Services

Healthcare Claims Management Solution Type Outlook (Revenue, USD Million, 2017 - 2030)

• Integrated Solutions
• Standalone Solutions

Healthcare Claims Management Deployment Mode Outlook (Revenue, USD Million, 2017 - 2030)

• Cloud-based
• On-premise
• Web-based

Healthcare Claims Management End-use Outlook (Revenue, USD Million, 2017 - 2030)

• Healthcare Providers
• Healthcare Payers

Healthcare Claims Management Regional Outlook (Revenue, USD Million, 2017 - 2030)

• North America
  • US.
  • Canada
• Europe
  • UK.
  • Germany
  • France
  • Italy
  • Spain
• Asia Pacific
  • Japan
  • China
  • India
  • Australia
  • South Korea
• Latin America
  • Brazil
  • Mexico
  • Argentina
• Middle East & Africa
  • South Africa
  • Saudi Arabia
  • Israel

List of Key Players in the Healthcare Claims Management Market

• McKesson Corporation
• The SSI Group, Inc.
• Quest Diagnostics
• Kareo
• Optum, Inc. (a subsidiary of UnitedHealth Group)
• Conifer Health Solutions
• CareCloud
• eClinicalWorks
• IBM
• Cerner Corporation

About Grand View Research

Grand View Research, Inc. is a U.S. based market research and consulting company, registered in the State of California and headquartered in San Francisco. The company provides syndicated research reports, customized research reports, and consulting services. To help clients make informed business decisions, we offer market intelligence studies ensuring relevant and fact-based research across a range of industries, from technology to chemicals, materials and healthcare.