Medical Claims Management Solutions Market - Research Report, Size, Analysis and Demand, 2023

A medical claim is a detailed invoice that a health care provider sends to the health insurer, exactly showing the services that have been rendered by the providers to the patient. Medical claims management involves multiple administrative and customer service layers that include review, investigation, adjustment, remittance or denial of a claim. Improved focus on quality healthcare services and adoption of cloud technology related services are contributing to the growth of the medical claims management solutions market. Medical claims management solutions generally aim at attaining complete automation of processing of claims, faster access to customer information without negotiating on the security of private medical information. However, insurance claim payers and providers need to be convinced about the need for these solutions and also the benefits of investing in them despite their sizeable cost. Automation helps in reducing costs associated with processing of claims, utilizing a single platform for all data sources, workflows for routing claims for review and approval processes, increasing the uniformity of payments, and timely payment of claims. According to the National Health Insurer Report Card published in 2011 by American Medical Association (AMA), around $17 billion a year (on an average) could be saved by eliminating errors in claims. Automation reduces the paper storage and document retrieval costs while complying with regulatory standards such as Health Insurance Portability and Accountability Act (HIPAA). Health insurance payers invest in their claims management systems to gain interoperability and faster release of new insurance claims, in addition to, improving efficiency of claims processing.

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The medical claims management solutions market is driven by factors such as advent of new and innovative treatments & technologies, improved focus on quality healthcare services and adoption of cloud-based technology related services. Moreover, increase in the number of patients covered under medical insurance and expensive care required for chronic diseases have supported the growth of the medical claims management solutions industry. Also, the increase in aging population, initiatives taken by government in order to improve insurance coverage among citizens and rise in occurrence of chronic diseases affect the market thus, driving the growth of medical claims management solutions market. According to the World Health Organization (WHO), contribution of chronic diseases is expected to rise to 73% of all deaths and 60% of the global burden of disease by 2020. Moreover, 79% of the deaths attributed to these diseases occur in developing countries. Additionally, as per United Nations Department of Economic and Social Affairs (UN-DESA) report on the global aging population, the population of people aged 60 years or above is growing at a high rate. The number of people aged 60 years or over is projected to grow by 56.0 % globally, i.e. from 901 million in 2015 to 1.4 billion by 2030, and it is projected to more than double its size from 2015, to reach 2.1 billion by 2050.

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The major players in the medical claims management solutions market include IBM Corporation, Cerner Corporation, Oracle Corporation, Avaya Inc., Genpact Limited, Cognizant Technology Solutions Corporation, Accenture PLC, Allscripts Healthcare Solutions, Inc., Athenahealth Inc., Aspect Software Inc., and Infor Inc.

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