by The global 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 in processing insurance claims efficiently and timely while reducing overall healthcare costs. The service includes basic steps such as receiving and verifying claims, ensuring eligibility, determining reimbursement, issuing payments to providers and patients. Medical claims processing service providers leverage various healthcare IT solutions such as claims clearinghouse, billing management, electronic data interchange (EDI), payment processing and practice management software to streamline and automate the overall claims process.
Market key trends:
One of the key trends in the Medical Claims Processing Services Market Trend is the growing adoption of cloud-based and AI-powered solutions. Cloud-based models are gaining traction as they are more scalable, flexible and cost-effective. AI and machine learning capabilities enable automated rules-based adjudication of claims to speed up the process. AI can also help detect fraudulent claims patterns and ensure regulatory compliance. With the advancement of digital technologies, machine learning and predictive analytics are further expected to optimize the claims processing workflow in the coming years.
Porter’s Analysis
Threat of new entrants: The threat of new entrants is relatively low in the medical claims processing services market owing to large capital investments and the need for specialized insurance expertise.
Bargaining power of buyers: The bargaining power of buyers is moderate due to standard terms and conditions across the industry. However, large insurance companies have higher bargaining power.
Bargaining power of suppliers: The bargaining power of suppliers is moderate due to availability of substitutes. However, suppliers with specialized skills have some bargaining power.
Threat of new substitutes: The threat of substitutes is moderate as there are few alternative options for processing medical claims efficiently at scale.
Competitive rivalry: The competitive rivalry is high due intense competition among existing players.
Key Takeaways
The global Medical Claims Processing Services market is expected to witness high growth, exhibiting CAGR of 4.4% over the forecast period, due to increasing demand for reducing healthcare costs.
Regional analysis:
North America dominates the medical claims processing services market and is expected to continue its dominance over the forecast period. This is attributed to advanced healthcare infrastructure and early adoption of technologically advanced solutions in the region. Asia Pacific is expected to exhibit the fastest growth over the forecast period owing to improving healthcare facilities and growing medical tourism in the region.
Key players
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. Cerner Corporation and McKesson Corporation captured over 20% of market share in 2023.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
