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Healthcare EDI Market: Opportunities and Challenges

11-01-2019 07:20 AM CET | Health & Medicine

Press release from: MarketsandMarkets

Healthcare EDI Market

Healthcare EDI Market

The Global Healthcare EDI Market is valued at USD 2.56 billion in 2017 and is expected to reach to USD 3.77 billion by 2022 growing at a CAGR of 8.1% during the forecast period (2017 to 2022), as per a report by MarketsandMarkets.

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Why increase in outsourcing of EDI services presents an opportunity?

EDI outsourcing is the process of having a third party manage a part or the entire process of using EDI to exchange data with trading partners. Growing healthcare costs are increasingly pressurizing the healthcare industry to provide quality care at lower costs by minimizing wastages at each stage. Healthcare revenue loss in American hospitals, due to self-pay billing issues, is as high as 20% to 30%.

Additionally, according to a Ponemon Institute survey in 2014, of 577 healthcare professionals, the U.S. physicians and hospitals have shown an inability to use the latest mobile devices and internet services to deliver patient care. As a result, U.S. hospitals absorb an estimated USD 8.3 billion annually, while struggling with security and privacy concerns arising from the mainstreaming of social media at a time when federal rules allow for steep fines when it comes to violating patient privacy. For hospitals, this makes the outsourcing of billing and claim services to EDI service providers an attractive proposition.

This has resulted in an increased adoption of HCIT solutions and outsourcing of non-core healthcare delivery services such as administration, claims management, billing, and reimbursements to a third-party vendor. Hospitals are looking to outsource their application maintenance services as well as their application integration and development for electronic medical records (EMR), customer relationship management (CRM), revenue cycle management (RCM), billing system, and so on. For this, hospitals prefer private IT vendors to provide the requisite technology and expertise to support IT infrastructure and services. This increase in outsourcing EDI services in healthcare provides opportunities for various clearinghouses and healthcare EDI vendors to contribute to the market.

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How hesitancy to switch from conventional methods poses a challenge?

According to the CAQH Index, 2016, the healthcare industry continues to make modest progress in terms of the full adoption of electronic transactions. The adoption of electronic transactions varied across types of transactions, increasing by 1% to 8%. Only 6% of healthcare claim attachments were submitted to medical health plans electronically (using the ASC X12N 275 transaction standard), with the remaining sent via fax, mail, or email.

This lag in the adoption of healthcare EDI by providers continues to be a significant challenge for healthcare EDI industry. While the use of electronic transactions for eligibility & benefit verifications and claim status inquiries is increasing rapidly, the use of manual transactions, particularly telephone calls, is not declining as rapidly. For instance, participating medical and dental health plans alone fielded over 106 million telephone calls for these types of inquiries in 2015. The hesitation to switch to electronic data interchange, due to budgetary constraints and preference for conventional methods, has slowed the growth of the market; this is expected to continue in the coming years.

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Mr. Shelly Singh
MarketsandMarkets™ INC.
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Suite 430
Northbrook, IL 60062
USA : 1-888-600-6441

About MarketsandMarkets™:

MarketsandMarkets™ provides quantified B2B research on 30,000 high growth niche opportunities/threats which will impact 70% to 80% of worldwide companies’ revenues. Currently servicing 7500 customers worldwide including 80% of global Fortune 1000 companies as clients. Almost 75,000 top officers across eight industries worldwide approach MarketsandMarkets™ for their painpoints around revenues decisions.

Our 850 fulltime analyst and SMEs at MarketsandMarkets™ are tracking global high growth markets following the "Growth Engagement Model – GEM". The GEM aims at proactive collaboration with the clients to identify new opportunities, identify most important customers, write "Attack, avoid and defend" strategies, identify sources of incremental revenues for both the company and its competitors. MarketsandMarkets™ now coming up with 1,500 MicroQuadrants (Positioning top players across leaders, emerging companies, innovators, strategic players) annually in high growth emerging segments. MarketsandMarkets™ is determined to benefit more than 10,000 companies this year for their revenue planning and help them take their innovations/disruptions early to the market by providing them research ahead of the curve.

MarketsandMarkets’s flagship competitive intelligence and market research platform, "Knowledge Store" connects over 200,000 markets and entire value chains for deeper understanding of the unmet insights along with market sizing and forecasts of niche markets.

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