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.
Medical claims processing services evaluate patient coverage, verify eligibility, determine medical necessity, consolidate charges, prepare bills, process payments and other key claims management functions for healthcare payers, providers and employers. Growing demand for paperless, digital and efficient processing is driving demand for cloud-based claims processing services, which enable easy sharing and access of claims information for healthcare stakeholders.
Medical claims processing involves reviewing bills from healthcare providers and determining appropriate coverage and reimbursement amounts owed. With rising healthcare costs and complex regulations, healthcare payers outsource claims processing to third party administrators for efficiency and cost savings.
Market key trends:
One of the key trends in the Medical Claims Processing Services Market Trend is the shift from traditional paper-based claim submissions to electronic submission and processing of claims. This transition has streamlined the overall claims management process making it more efficient through electronic data sharing between payers and providers. Electronic claims processing has significantly reduced administrative costs for stakeholders and improved transparency in billing.
Content: The medical claims processing services market is segmented based on product type, deployment model, and end user. Among the product type, integrated solutions segment dominates the market and is expected to continue its dominance over the forecast period. Integrated solutions provide streamlined workflows, centralized data management, and a 360-degree view of patients, which makes it an appealing option for payers and providers.
Market size: 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 focus on improving medical expense reimbursement rates and reducing operational costs.
Regional analysis: North America dominated the medical claims processing services market in 2023 and is expected to continue its dominance over the forecast period. This is attributed to well-established healthcare infrastructure and presence of major market players in the region. Asia Pacific is anticipated to grow at the fastest rate owing to rising healthcare expenditure and improving healthcare facilities in emerging countries.
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, and Conifer Health Solutions. Cerner Corporation and McKesson Corporation captured a substantial share of the market owing to their vast product portfolio and global presence.