U.S. Healthcare Denial Management Market to Reach USD 5.94 Billion by 2027. AI & Automation to Boost Innovation & Accuracy – Arizton

Subheading: The shift towards value-based reimbursement, increasing demand for standardization, and the use of AI to develop solutions are some latest trends in the U.S. healthcare denial management market.

According to the in-depth report on Arizton’s, U.S. healthcare denial management market is expected to grow at a CAGR of over 8.86% during the period 2021−2027. Web and cloud-based denial management are likely to witness the highest absolute growth of 69.33% and a CAGR of 9.17% in the next 5 years.

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KEY HIGHLIGHTS OFFERED IN THE REPORT:
1. The healthcare denial management market in the US will grow with the need to reduce and manage claim denial and decrease the revenue impact to healthcare systems due to the loss in denials.
2. In 2021, the soft denial accounted for the largest share due to an increase in claim submission/billing errors, duplicate claims, and lack of documentation.
3. In 2021, integrated accounted for the highest share due to its incorporation with electronic health records, medical billing, and practice management.
4. In 2021, web & cloud-based accounted for highest share due to its advantages of cost-effectivity, automated workflow, remotely delivering updates, and others.
5. In 2021, healthcare providers accounted for the highest share in the market due to their increased adoption of denial management.

Key Offerings:
• Market Size & Forecast by Revenue | 2021−2027
• Market Dynamics – Leading trends, growth drivers, restraints, and investment opportunities
• Market Segmentation – A detailed analysis by component, type, delivery mode, and end-user
• Competitive Landscape – 6 key vendors and 60 other vendors

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U.S. HEALTHCARE DENIAL MANAGEMENT MARKET – SEGMENTATION

• In 2021, the soft denial segment accounted for 58.36% of the US healthcare denial management market. A soft denial is usually rejected instead of being denied by the insurer. This usually occurs if the insurance company reviews a claim due is some minor issue.
• Integrated denial management helps patients and hospitals by sharing electronic records, sending reminders, personalizing patient treatment, obtaining performance reports, managing and estimating referral payments, offline medical camp management, and others.
• Web and cloud-based deployment of healthcare denial management is a proven, fast, and cost-effective way to accelerate digital initiatives without the need for infrastructure and setup costs. Cloud-based denial management offers benefits such as fully featured workflow automation solutions, such as automatic software updates, reduced software dependency, lower support and administration costs, and easy scaling based on imminent requirements.

Market Segmentation by Component
• Soft Denial
• Hard Denial
Market Segmentation by Type
• Integrated
• Standalone
Market Segmentation by Delivery Mode
• Web & Cloud-Based
• On-Premises
Market Segmentation by End-User
• Healthcare Providers
• Hospitals
• Physician’s Office
• Others
• Healthcare Payers

U.S. HEALTHCARE DENIAL MANAGEMENT MARKET – DYNAMICS
Most denials also occur because of prior authorization and medical necessity issues. An AI-powered prior authorization solution helps in reducing claim denials by automating multiple steps throughout the process. These range from determining the need for authorization to helping submit prior authorization requests with EHR data to continually checking prior authorization statuses. In healthcare claims management, claims status checks are a vital step. About 48% of claim rejections and denials go unworked or un-appealed. Hence, automation of claims status checks might not reduce denials but save significant staff time that can redirect to other steps in the revenue cycle process, including reworking denials. Employing automation to assess thousands of claims can help in defining a successful claim. The overall number of denials can be reduced by looking for missing documentation before sending out the claim through training the AI engine and communicating with the clinical and/or administrative teams to fill gaps.
KEY DRIVERS AND TRENDS FUELING MARKET GROWTH:
• Rising Importance of Denial Management in Medical Claims
• Increase in Outsourcing of Denial Management
• Growing Volume of Medical Claim Denials
• Increasing Payer Complexities for Healthcare Claims

U.S. HEALTHCARE DENIAL MANAGEMENT MARKET – COMPETITOR LANDSCAPE
The US healthcare denial management market is highly fragmented and competitive. The market is characterized by rapid technological change, including cloud-based medical billing management. The integration of electronic health records usage increased usage of the digital medium has revolutionized the claim denials. Vendors are also constantly coming up with new technologies to develop, acquire and market new services to access a new set of consumers. Several players face competition from vendors of specialized software solutions that offer similar billing solutions at significantly low prices. They also develop additional products and have become more sophisticated and effective. Established companies are acquiring or collaborating with smaller vendors, offering complementary products, technologies, or services to expand their presence in the market. Moreover, several key players indulge in mergers and acquisitions to remain competitive and expand their reach through inorganic growth strategies.

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Major Vendors
• UnitedHealth Group
• McKesson
• Change Healthcare
• eClinicalWorks
• Experian
• Allscripts Healthcare Solutions

Other Prominent Vendors
• 24/7 Medical Billing Services
• 3D Solutions
• 3Gen Consulting
• 4D Global
• Access Healthcare
• Acrologic Business Solutions
• AdvancedMD
• AdvantEdge Healthcare Solutions
• Advantum Health
• Aergo Solutions
• Aetna
• Alaska Billing Services
• AllianceMed
• BillingParadise
• Bizmatics
• CareCloud
• ChartLogic
• Cigna
• Cognizant
• Coronis Health
• Craneware
• Credit Management Company
• CureMD Healthcare
• Data Marshall
• DrChrono
• EHealthSource
• Greenway Health
• Golden West Medical Billing
• InSync Healthcare Solutions
• IntelliRCM
• Intersect Healthcare
• iSalus
• Kareo
• McBee Associates
• MedEx Medical Billing
• Medforce Technologies
• Medical Billers and Coders
• Medmecs Billing Services
• MGSI
• MRO
• NXGN Management
• OSP
• Persistent Systems
• PMMC
• Procure Billing Solutions
• Promantra
• Quadax
• QWay Healthcare
• R1 RCM
• Resolutions Billing & Consulting
• Revele
• RevenueXL
• Right Medical Billing
• Savista
• Superior Medical Management
• TriMed Technologies
• Vee Technologies
• Vitruvian MedPro
• Waystar

Explore our healthcare & lifesciences profile to know more about the industry.

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ABOUT ARIZTON:
Arizton Advisory and Intelligence is an innovation and quality-driven firm that offers cutting-edge research solutions to clients worldwide. We excel in providing comprehensive market intelligence reports and advisory and consulting services.
We offer comprehensive market research reports on industries such as consumer goods & retail technology, automotive and mobility, smart tech, healthcare, and life sciences, industrial machinery, chemicals and materials, IT and media, logistics and packaging. These reports contain detailed industry analysis, market size, share, growth drivers, and trend forecasts.
Arizton comprises a team of exuberant and well-experienced analysts who have mastered in generating incisive reports. Our specialist analysts possess exemplary skills in market research. We train our team in advanced research practices, techniques, and ethics to outperform in fabricating impregnable research reports.

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