by The Medical Claims Processing Services Market is estimated to be valued at US$ 15.57 Bn in 2023 and is expected to exhibit a CAGR of 4.4% over the forecast period 2023 to 2030, as highlighted in a new report published by Coherent Market Insights.
Market Overview:
Medical claims processing services help healthcare providers, insurance payers, and billing management companies with a wide range of administrative functions including claims submission, eligibility verification, medical coding, billing statement generation, payment remittance, and more. This helps reduce the workload of healthcare providers and payers and ensure smooth reimbursements. Key players offer cloud-based medical claims processing software with features like real-time claims status tracking, automated workflows, digital forms, integration with EHR/EMR systems.
Market Dynamics:
One of the major drivers for the medical claims processing services market is the growing healthcare costs which necessitate the need for efficient claims management. According to CMS, the national healthcare spending is projected to grow at an average rate of 5.4% annually from 2020-2030 reaching nearly $6.2 trillion by 2028. Furthermore, the adoption of automation technologies like AI and machine learning is revolutionizing the medical claims processing market. AI can help analyze large claims data, identify errors and fraud patterns, optimize workflow processes. Companies are offering AI-powered cloud platforms to reduce costs and improve productivity for healthcare providers and payers.
Segment Analysis
The Medical Claims Processing Services Market Trend is segmented based on the type of claims which includes dental claims, medical claims, and pharmacy claims. Among these, the medical claims sub-segment dominates the market as it requires processing claims for healthcare services such as doctor visits, laboratory tests etc., and comprises of higher volume of transactions compared to other segments. The medical claims segment accounts for over 50% share of the total market owing to the high requirement and complex nature of medical claims processing.
PEST Analysis
Political: Regulations pertaining to medical reimbursements are driving the need for efficient medical claims processing services from third party providers.
Economic: Growing healthcare expenditure in major countries and rise in insurance coverage is fueling the demand for these outsourced services.
Social: Increasing healthcare awareness and focus on preventive care is resulting in higher consumption of medical services and thereby augmenting the volume of claims to be processed.
Technological: Adoption of advanced technologies like artificial intelligence, blockchain, and cloud computing is helping companies provide faster and error-free processing of voluminous claims data.
Key Takeaways
The global medical claims processing services market is expected to witness high growth, exhibiting CAGR of 4.4% over the forecast period 2023 to 2030, due to increasing healthcare expenditure globally. The market size for 2023 is estimated to be US$ 15.57 Bn.
Regionally, the North America medical claims processing services market holds the major share currently owing to well-established healthcare infrastructure and healthcare IT adoption in the region. Asia Pacific is projected to witness fastest growth during the forecast period supported by rising medical tourism, presence of major BPO service providers and expanding healthcare coverage in countries like India, China and others.
Key players operating in the medical claims processing services market are Cerner Corporation, McKesson Corporation, Accenture plc., Genpact Limited, eClinicalWorks, Cognizant Technology Solutions Corporation , Oracle Corporation, IBM Corporation, Conifer Health Solutions. The top players are focusing on inorganic growth strategies like acquisitions to enhance their service offerings and geographic footprint. For instance, Cognizant acquired Clinithink in 2020 to expand its clinical content and decision support capabilities.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
