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Market Research Report

Global Healthcare Claims Management Market - Segmented by Solution Type (Integrated and Standalone), by Component (Services and Software), by Delivery Mode, End User, and Geography - Growth, Trends, and Forecast (2018 - 2023)

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Global Healthcare Claims Management Market - Segmented by Solution Type (Integrated and Standalone), by Component (Services and Software), by Delivery Mode, End User, and Geography - Growth, Trends, and Forecast (2018 - 2023)
Published: September 1, 2018 Content info: 114 Pages
Description

The Global Healthcare Claims Management Market is expected to register a CAGR of nearly 5.1 % during the forecast period, 2018-2023. United States healthcare claims management market will increase due to introduction of Patient Protection and Affordable Care Act (PPACA). North America is expected to have largest market share and Asia is also grow at highest CAGR due to advancements in healthcare IT solutions.

Rising Importance Of Denials Management

Denial of claims by insurers are very common and is the main cause for revenue loss for many healthcare providers. On first submission more than 30% of the healthcare claims are denied. Most hospitals fail to resubmit the claims. Denials Management has an important role to play in hospital revenue generation. Most hospitals are now dependent on third party providers for denials management service as they lack the expert knowledge and the time to manage the reimbursement process. Third party providers with dedicated and skilled professionals are able to handle the denied claim and resubmit them. With their expertise these providers are able to increase the cash flow of their clients which were otherwise neglected by the hospitals to resubmit the denied claims. It is estimated that over 90% of the claim denials can be prevented with support from providers who have systems and knowledge experts in this field. Denials management team maximize revenue collection by understanding the cause for claim denial along with helping the hospitals provide better patient satisfaction. These teams have become back bone for hospitals as they have rich experience in appealing to insurer for approval as per their filing process, thus contributing to the growth of healthcare claims management market. Other factors that drive this market include government initiatives supporting health insurance market and growing aging population with chronic diseases.

Patient Data Privacy and Security Concerns

Healthcare being the most personal services provided in our society, for safer and appropriate delivery of care to patients and management of Healthcare Claims Management activities, most providers collect various data points on patient personal information such as: medication history, disease history and surgical procedures undergone etc. There is an increasing concern over how healthcare providers use these patient's information and protect its confidentiality. The loss of privacy of patient data is common when healthcare staff shares the information with other organizations despite the mandatory requirements in place to provide assurance to patients. The above factors may hinder the growth of healthcare claims management market in the forecast period. Other factor impeding the growth of this market include high deployment costs.

The US is the Chief Region for Healthcare Claims Management Market

Most hospitals in United States serving patients who are covered under Medicare or any privates insurances are facing difficulty in processing and submitting claims. Hospitals face challenge in accurately billing patients for a procedure or surgery done. This has created a huge opportunity for companies that provide Healthcare Claims Management to bridge the gap. Healthcare payers face the challenge of managing complex provider networks. In United States most providers and payers are dependent on third party companies that are efficient and pioneer in claims management services eg: PokitDok's Healthcare Claims Management suite automates claims processing thereby increase clean claim rates, and minimize revenue leakages. All the above factors may propel the Healthcare Claims Management market in United States over the forecasted period.

Key Developments in the Healthcare Claims Management Market Report:

  • Jun 2018: McKesson Corporation completed the previously announced acquisition of Medical Specialties Distributors
  • Major players: ACCENTURE, ATHENAHEALTH INC, CERNER CORPORATION, GEBBS HEALTHCARE SOLUTIONS, GENPACT LIMITED, HEALTH SOLUTIONS PLUS, IBM CORPORATION, MCKESSON CORPORATION, OPTUM, INC, and ORACLE CORPORATION among others.

Reasons to Purchase the Report:

  • Current and future of Healthcare Claims Management Market outlook in the developed and emerging markets
  • Analysis of various perspectives of the market with the help of Porter's five forces analysis
  • The segment that is expected to dominate the market
  • Regions that are expected to witness the fastest growth during the forecast period
  • Identify the latest developments, market shares, and strategies employed by the major market players
  • 3-month analyst support, along with the Market Estimate sheet (in Excel)

Customization of the Report:

This report can be customized to meet your requirements. Please connect with our representative, who will ensure you to get a report that suits your needs

Table of Contents
Product Code: 64360

Table of Contents

1. Introduction

  • 1.1. Market Definition

2. Research Methodology

3. Executive Summary

4. Key Inferences

5. Market Overview

  • 5.1. Current Market Scenario
  • 5.2. Porter's Five Forces Analysis
    • 5.2.1. Bargaining Power of Suppliers
    • 5.2.2. Bargaining Power of Consumers
    • 5.2.3. Threat of New Entrants
    • 5.2.4. Threat of Substitute Product and Services
    • 5.2.5. Degree of Competition

6. Market Dynamics

  • 6.1. Drivers
    • 6.1.1. Government Initiatives Supporting Health Insurance Market
    • 6.1.2. Rising Importance of Denials Management
    • 6.1.3. Growing Aging population with chronic diseases
  • 6.2. Restraints
    • 6.2.1. Patient Data Privacy and Security Concerns
    • 6.2.2. High Deployment Costs
  • 6.3. Opportunities
  • 6.4. Challenges

7. Market Segmentation

  • 7.1. By Solution Type
    • 7.1.1. Integrated Solutions
    • 7.1.2. Standalone Solutions
  • 7.2. By Component
    • 7.2.1. Services
    • 7.2.2. Software
  • 7.3. By Delivery Mode
    • 7.3.1. On-Premise
    • 7.3.2. Cloud-Based
  • 7.4. By End User
    • 7.4.1. Healthcare Payers
    • 7.4.2. Healthcare Providers
    • 7.4.3. Other End Users
  • 7.5. By Geography
    • 7.5.1. North America
      • 7.5.1.1. United states
      • 7.5.1.2. Canada
      • 7.5.1.3. Mexico
    • 7.5.2. Europe
      • 7.5.2.1. France
      • 7.5.2.2. United Kingdom
      • 7.5.2.3. Germany
      • 7.5.2.4. Spain
      • 7.5.2.5. Italy
      • 7.5.2.6. Rest of Europe
    • 7.5.3. Asia-Pacific
      • 7.5.3.1. India
      • 7.5.3.2. China
      • 7.5.3.3. Japan
      • 7.5.3.4. Australia
      • 7.5.3.5. South Korea
      • 7.5.3.6. Rest of Asia-Pacific
    • 7.5.4. Middle East & Africa
      • 7.5.4.1. GCC
      • 7.5.4.2. South Africa
      • 7.5.4.3. Rest of Middle East & Africa
    • 7.5.5. South America
      • 7.5.5.1. Brazil
      • 7.5.5.2. Argentina
      • 7.5.5.3. Rest of South America

8. Company Profiles & Competitive Landscape

  • 8.1. Accenture plc.
  • 8.2. Athenahealth Inc
  • 8.3. Cerner Corporation
  • 8.4. Gebbs healthcare solutions
  • 8.5. Genpact limited
  • 8.6. Health solutions plus
  • 8.7. IBM Corporation
  • 8.8. Mckesson Corporation
  • 8.9. Optum, Inc
  • 8.10. Oracle Corporation

List Not Exhaustive

9. Future of the Market

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