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Healthcare Claims Management Software Market: Introduction

  • Healthcare claims management is a process that involves numerous tasks such as billing, organization, updating, filing and processing of medical claims related to the treatment, diagnosis, and medication of patients. Healthcare claims management software manages medical claims and reimbursement processes in the healthcare sector.
  • Furthermore, healthcare claims management software is used to streamline the medical claims process, which eases the relationship between provider and insurance company, in order to efficiently speed up the patient’s payment lifecycle.
  • The COVID-19 pandemic has strained the healthcare system worldwide. Ensuring timely treatment and complete patient safety is the major concern during this pandemic outbreak. Healthcare claims management software plays an important role in restoring the trust of people, as no country, whether developed or developing, has an infrastructure or software that can deal with this virus. Epidemiological handling and preventive strategies are being implemented with the help of healthcare claims management software in order to relieve the strained healthcare facilities across the world.

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Global Healthcare Claims Management Software Market: Dynamics

Global Healthcare Claims Management Software Market: Key Drivers and Restraints

  • Increase in aging population, and rise in incidence of COVID -19, is expected to be the major factor boosting the growth of the healthcare claims management software market.
  • Besides, improved focus on quality healthcare services and advent of innovative treatments & technologies in the healthcare sector across the world is expected to drive the market.  
  • Furthermore, increasing importance of denials management is expected to fuel the growth of the market over the forecast period.
  • Rising initiatives of governments in developing countries to provide better healthcare services, in order to improve healthcare infrastructure is expected to drive the healthcare claims management software market.
  • Moreover, rising investments by governments of both developed and developing economies to modernize the healthcare infrastructure and also to adopt healthcare IT solutions is expected to enhance the growth of the market worldwide.
  • However, increasing concerns about patient data safety & security and rise in cybercrime are expected to hamper the healthcare claims management software market.
    • For instance, according to the National Health Insurer Report Card published in 2011 by American Medical Association (AMA), around US$17 Bn a year (on an average) could be saved by removing errors in claims.

Asia Pacific to Account for Major Share of the Global Healthcare Claims Management Software Market

  • In terms of region, the global healthcare claims management software market can be divided into North America, Europe, Asia Pacific, Middle East & Africa, and South America.
  • The healthcare claims management software market in North America is anticipated to expand at a rapid pace over the forecast period, due to well-established players. This in turn is expected to boost the growth of the market in the region.
  • Europe is expected to hold significant share in the global healthcare claims management software market due to the increased use of software and hardware for processing claims, and presence of top insurance companies in the region.
  • The healthcare claims management software market in Asia Pacific is expected to hold a significant share due to rising awareness of medical claims across the region, which in turn is expected to boost the market. India and China are the major countries enhancing the growth of the healthcare claims management software market, due to rising population.

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Global Healthcare Claims Management Software Market: Competitive Landscape

Key Players Operating in the Global Healthcare Claims Management Software Market

Local, regional, and international players are active in the healthcare claims management software market. The market is highly consolidated, with top manufacturers accounting for approximately 25%–30% share of the market. Key players operating in the global healthcare claims management software market are:

  • Athenahealth
  • Cerner Corporation.
  • Comindware Inc.
  • Conifer Health Solutions, LLC.
  • eClinicalWorks
  • McKesson Corporation
  • nThrive, Inc
  • Optum, Inc.
  • OSPLabs
  • PLEXIS Healthcare Systems
  • PokitDok, Inc.
  • Thermo Fisher Scientific Inc.

Global Healthcare Claims Management Software Market: Research Scope

Global Healthcare Claims Management Software Market Segmentation, by Deployment   

  • On-premise
  • Cloud- based

Global Healthcare Claims Management Software Market Segmentation, by Component      

  • Software
    • Integrated Solutions
    • Standalone Solutions
  • Services
    • Professional Services
      • Training & Consulting
      • Support & Maintenance
      • Integration & Implementation
    • Managed Services

Global Healthcare Claims Management Software Market Segmentation, by Solution

  • Claims Integration
  • Claims Review Management
  • Claims Management Reporting
  • Claims Status Management
  • Remittance Management Solutions
  • Others 

Global Healthcare Claims Management Software Market Segmentation, by End-user    

  • Healthcare Providers
  • Healthcare Payers

Global Healthcare Claims Management Software Market Segmentation, by Region

  • North America
    • U.S.
    • Canada
    • Rest of North America
  • Europe
    • Germany
    • France
    • U.K.
    • Rest of Europe
  • Asia Pacific
    • China
    • Japan
    • India
    • Australia
    • Rest of Asia Pacific
  • Middle East & Africa
    • U.A.E.
    • Saudi Arabia
    • South Africa
    • Rest of Middle East & Africa
  • South America
    • Brazil
    • Rest of South America

This study by TMR is all-encompassing framework of the dynamics of the market. It mainly comprises critical assessment of consumers' or customers' journeys, current and emerging avenues, and strategic framework to enable CXOs take effective decisions.

Our key underpinning is the 4-Quadrant Framework EIRS that offers detailed visualization of four elements:

  • Customer Experience Maps
  • Insights and Tools based on data-driven research
  • Actionable Results to meet all the business priorities
  • Strategic Frameworks to boost the growth journey

The study strives to evaluate the current and future growth prospects, untapped avenues, factors shaping their revenue potential, and demand and consumption patterns in the global market by breaking it into region-wise assessment.

The following regional segments are covered comprehensively:

  • North America
  • Asia Pacific
  • Europe
  • Latin America
  • The Middle East and Africa

The EIRS quadrant framework in the report sums up our wide spectrum of data-driven research and advisory for CXOs to help them make better decisions for their businesses and stay as leaders.

Below is a snapshot of these quadrants.

1. Customer Experience Map

The study offers an in-depth assessment of various customers’ journeys pertinent to the market and its segments. It offers various customer impressions about the products and service use. The analysis takes a closer look at their pain points and fears across various customer touchpoints. The consultation and business intelligence solutions will help interested stakeholders, including CXOs, define customer experience maps tailored to their needs. This will help them aim at boosting customer engagement with their brands.

2. Insights and Tools

The various insights in the study are based on elaborate cycles of primary and secondary research the analysts engage with during the course of research. The analysts and expert advisors at TMR adopt industry-wide, quantitative customer insights tools and market projection methodologies to arrive at results, which makes them reliable. The study not just offers estimations and projections, but also an uncluttered evaluation of these figures on the market dynamics. These insights merge data-driven research framework with qualitative consultations for business owners, CXOs, policy makers, and investors. The insights will also help their customers overcome their fears.

3. Actionable Results

The findings presented in this study by TMR are an indispensable guide for meeting all business priorities, including mission-critical ones. The results when implemented have shown tangible benefits to business stakeholders and industry entities to boost their performance. The results are tailored to fit the individual strategic framework. The study also illustrates some of the recent case studies on solving various problems by companies they faced in their consolidation journey.

4. Strategic Frameworks

The study equips businesses and anyone interested in the market to frame broad strategic frameworks. This has become more important than ever, given the current uncertainty due to COVID-19. The study deliberates on consultations to overcome various such past disruptions and foresees new ones to boost the preparedness. The frameworks help businesses plan their strategic alignments for recovery from such disruptive trends. Further, analysts at TMR helps you break down the complex scenario and bring resiliency in uncertain times.

The report sheds light on various aspects and answers pertinent questions on the market. Some of the important ones are:

1. What can be the best investment choices for venturing into new product and service lines?

2. What value propositions should businesses aim at while making new research and development funding?

3. Which regulations will be most helpful for stakeholders to boost their supply chain network?

4. Which regions might see the demand maturing in certain segments in near future?

5. What are the some of the best cost optimization strategies with vendors that some well-entrenched players have gained success with?

6. Which are the key perspectives that the C-suite are leveraging to move businesses to new growth trajectory?

7. Which government regulations might challenge the status of key regional markets?

8. How will the emerging political and economic scenario affect opportunities in key growth areas?

9. What are some of the value-grab opportunities in various segments?

10. What will be the barrier to entry for new players in the market?

Note: Although care has been taken to maintain the highest levels of accuracy in TMR’s reports, recent market/vendor-specific changes may take time to reflect in the analysis.

Custom Market Research Services

TMR offers custom market research services that help clients to get information on their business scenario required where syndicated solutions are not enough.


Healthcare Claims Management Software Market