Healthcare Claim Management Market - Growth, Trends, COVID-19 Impact, and Forecasts (2021 - 2026)

The market is segmented by solution type, component, delivery mode (On-Premise and Cloud-Based), end user, and geography.

Market Snapshot

Healthcare Claims Management Market Overview
Study Period: 2018 - 2026
Base Year: 2020
Fastest Growing Market: Asia Pacific
Largest Market: North America

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Market Overview

The major factors for the growth of the healthcare claim management market include the government initiatives supporting the health insurance market, the rising importance of denials management, and growing aging population with chronic diseases.

Denial of claims by insurers is very common and is the main cause of revenue loss for many healthcare providers. On the first submission, more than 30% of healthcare claims are denied. Most hospitals fail to resubmit their claims. Denial management has an important role to play in a hospital’s revenue generation. Most hospitals are now dependent on third-party providers for denial management services, as they lack the expert knowledge and the time to manage the reimbursement process. These providers, with dedicated and skilled professionals, are able to handle the denied claims and resubmit them. With their expertise, the providers are able to increase the cash flow of their clients neglected by the hospitals failing to resubmit the denied claims. It is estimated that over 90% of the claim denials can be prevented with support from providers, who have the system, knowledge, and expertise in this field. Denials management observes the most common trends in denial and puts appropriate systems in place for the prevention of future claims denial. Denial management team maximizes revenue collection by understanding the cause for claim denial, along with helping the hospitals provide better patient satisfaction. These teams have become the back bone for hospitals, as they have rich experience in appealing to an insurer for the approval of a claim as per their filing process. All the above factors are expected to contribute to the growth of the healthcare claim management market in the forecast period.

Scope of the Report

As per the scope of this report, healthcare claim management refers to services that enable healthcare payers to efficiently manage healthcare provider data and automate claims processes to help the healthcare provider claim submission and get faster approval. The market is segmented by solution type, component, delivery mode, end user, and geography.

By Solution Type
Integrated Solutions
Standalone Solutions
By Component
By Delivery Mode
By End User
Healthcare Payers
Healthcare Providers
Other End Users
North America
Rest of Europe
Asia Pacific
South Korea
Rest of Asia-Pacific
Middle East and Africa
South Africa
Rest of Middle East and Africa
South America
Rest of South America

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Key Market Trends

Cloud-based is the Segment by Delivery Mode is expected to Dominate the Market

The healthcare claim management market is complex, due to administration and processing activities across multiple systems. In addition, it has to adapt to a number of ever-changing regulations. Manual intervention may hamper the experience of good customers or providers, due to delays in processing, turn-around-time, and increased operational costs. Cloud-based claim management solutions reduce the claims processing time and control administrative costs. The claim administration cloud service is efficient in the management of entire claim administrative processes, such as adjudication, pricing, authorizations, and analytics. It enables real-time claim processing with no wait time for batch processes. With the decline in reimbursement rates, healthcare providers are opting for cloud-based services that reduce costs significantly and help insurers get paid on time. Thus, owing to the all above mentioned factors the market is expected to witness high growth over the forecast period.

Healthcare Claims Management Market Key Trends

North America is Expected to Dominate the Market

The United States spends a significant percentage of its GDP each year on healthcare. According to a recent report published by the Organization for Economic Co-operation and Development (OECD), about 18% of the country’s GDP was spent on healthcare in 2018. Most hospitals in the United States serving patients who are covered under Medicare or any privates insurances are facing difficulty in processing and submitting claims. Hospitals face challenges in accurately billing patients for a procedure or surgery. This has created a huge opportunity for companies that provide healthcare claim management to bridge the gap. Healthcare payers face the challenge of managing complex provider networks. In the United States, most of the providers and payers are dependent on third party companies who are efficient pioneers in claim management services For instance, PokitDok's healthcare claim management suite automates claims processing, thereby increasing the clean claim rates and minimizing revenue leakages. All the above factors may propel the healthcare claim management market in the United States over the forecast period.

Healthcare Claims Management Market Growth Rate

Competitive Landscape

The market studied is a moderately consolidated market owing to the presence of many small and large market players. Some of the market players are Accenture plc, Allscripts Healthcare Solutions, Inc., Athenahealth Inc, Cerner Corporation, Genpact limited, Health solutions plus, IBM Corporation, Mckesson Corporation, Optum, Inc, and Oracle Corporation.

Table of Contents


    1. 1.1 Study Deliverables

    2. 1.2 Study Assumptions

    3. 1.3 Scope of the Study




    1. 4.1 Market Overview

    2. 4.2 Market Drivers

      1. 4.2.1 Government Initiatives Supporting Health Insurance Market

      2. 4.2.2 Rising Importance of Denials Management

      3. 4.2.3 Growing Aging population with chronic diseases

    3. 4.3 Market Restraints

      1. 4.3.1 Patient Data Privacy and Security Concerns

      2. 4.3.2 High Deployment Costs

    4. 4.4 Porter's Five Force Analysis

      1. 4.4.1 Threat of New Entrants

      2. 4.4.2 Bargaining Power of Buyers/Consumers

      3. 4.4.3 Bargaining Power of Suppliers

      4. 4.4.4 Threat of Substitute Products

      5. 4.4.5 Intensity of Competitive Rivalry


    1. 5.1 By Solution Type

      1. 5.1.1 Integrated Solutions

      2. 5.1.2 Standalone Solutions

    2. 5.2 By Component

      1. 5.2.1 Services

      2. 5.2.2 Software

    3. 5.3 By Delivery Mode

      1. 5.3.1 On-Premise

      2. 5.3.2 Cloud-Based

    4. 5.4 By End User

      1. 5.4.1 Healthcare Payers

      2. 5.4.2 Healthcare Providers

      3. 5.4.3 Other End Users

    5. 5.5 Geography

      1. 5.5.1 North America

        1. US

        2. Canada

        3. Mexico

      2. 5.5.2 Europe

        1. Germany

        2. UK

        3. France

        4. Italy

        5. Spain

        6. Rest of Europe

      3. 5.5.3 Asia Pacific

        1. China

        2. Japan

        3. India

        4. Australia

        5. South Korea

        6. Rest of Asia-Pacific

      4. 5.5.4 Middle East and Africa

        1. GCC

        2. South Africa

        3. Rest of Middle East and Africa

      5. 5.5.5 South America

        1. Brazil

        2. Argentina

        3. Rest of South America


    1. 6.1 Company Profiles

      1. 6.1.1 Accenture plc

      2. 6.1.2 Allscripts Healthcare Solutions, Inc.

      3. 6.1.3 Athenahealth Inc

      4. 6.1.4 Cerner Corporation

      5. 6.1.5 Genpact limited

      6. 6.1.6 Health Solutions Plus

      7. 6.1.7 IBM Corporation

      8. 6.1.8 Mckesson Corporation

      9. 6.1.9 Optum, Inc

      10. 6.1.10 Oracle Corporation

    2. *List Not Exhaustive

**Subject to Availability
**Competitive Landscape covers- Business Overview, Financials, Products and Strategies and Recent Developments

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Frequently Asked Questions

The Healthcare Claim Management Market market is studied from 2018 - 2026.

The Healthcare Claim Management Market is valued at 5.1% in 2018.

Asia Pacific is growing at the highest CAGR over 2021- 2026.

North America holds highest share in 2020.

Accenture plc, Athenahealth Inc, Cerner Corporation, Genpact limited, Health Solutions Plus are the major companies operating in Healthcare Claim Management Market.

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