Healthcare EDI Market 2021 Is Booming Worldwide with: Optum (US), Allscripts Healthcare Solutions Inc. (US), athenahealth (US), and Nextgen Healthcare (US)

Healthcare EDI Market research report displays important product developments and tracks recent acquisitions, mergers and research in the industry by the key players. This finest market report is an all-inclusive overview of the market, covering various aspects including product definition, customary vendor landscape, and market segmentation based on various parameters such as type of product, its components, type of management and geography. This Healthcare EDI Market report has studied key opportunities in the market and influencing factors which is valuable to take business to the new level.

The global healthcare EDI market is projected to reach USD 4.4 billion by 2025 from USD 3.0 billion in 2020, at a CAGR of 7.8% during the forecast period. The key factors driving the growth of this market include the development of regulations for transaction processes, the rising need to curtail healthcare costs and government support for HCIT implementation. However, the high implementation cost and data security concerns are expected to restrict market growth to a certain extent. Hesitancy to switch from conventional methods may also challenge market growth in the coming years.

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McKesson Corporation (US), Optum (US), Allscripts Healthcare Solutions Inc. (US), athenahealth (US), and Nextgen Healthcare (US) are the key players operating in the healthcare EDI market. Other prominent players in this market include Cognizant Technology Corporation (US), SSI Group, LLC (US), Cerner Corporation (US), Comarch SA (Poland), Axway Software SA (France), Optum Inc. (US), Dell Technologies Inc. (US), Nextgen Healthcare (US), Synnex Corporation (US), Comarch (Poland), Axway Solutions (US), and Plexis Healthcare Systems (US).

“The mobile EDI segment will grow at the highest rate during the forecast period.”

Based on delivery mode, the global Healthcare EDI market is segmented into web & cloud-based EDI, EDI VAN, point-to-point EDI, and mobile EDI. The factors attributing to the high growth of the mobile EDI segment include the technological upgrades in the healthcare industry and the growing acceptance of mobile solutions among healthcare providers.

“By transaction type, the claims management segment accounted for the largest share of the Healthcare EDI market in 2019.”

On the basis of the transaction type, the global healthcare EDI market is segmented into claims management and supply chain management in 2019. The rising adoption of EDI services by healthcare providers and payers and the need to meet regulatory requirements are driving the increased uptake of healthcare EDI solutions for claims management.

“By-products & services, the services segment accounted for the largest share of the healthcare EDI market in 2019.”

The services segment is expected to witness a faster growth rate in this market due to factors such as, the increasing claims volume, increasing complexity, and scale of EDI solutions, as they require extensive training programs. Similarly, a growing trend of outsourcing activities, such as revenue cycle management, claims handling and management, and partner management services, is also expected to propel the growth of the services market.

“By end-user, the healthcare payers segment will grow at the highest rate during the forecast period.”

Based on end user, the healthcare EDI market is segmented into healthcare providers, healthcare payers, medical device & pharmaceutical industries, and pharmacies. The healthcare payers segment is expected to grow at the highest CAGR during the forecast period due to the increasing number of private insurance players in the market.

“The market in North America is projected to witness the highest growth rate during the forecast period (2020–2025).”

North America is projected to register the highest growth during the forecast period. This large share can be attributed to factors such as The rising HCIT expenditure, developed healthcare infrastructure, broad insurance coverage, a favorable regulatory scenario, an increasing number of private healthcare players, growing demand for healthcare supply chain management solutions, and the presence of prominent healthcare IT companies in this region, are responsible for the large share of the North American healthcare EDI market.

A breakdown of the primary participants referred to for this report is provided below:

  • By Company Type (Supply-side): Tier 1: 33%, Tier 2: 45%, and Tier 3: 22%
  • By Designation: C-level: 11%, Director-level: 45%, and Managers: 44%
  • By Region: North America: 36%, Europe: 21%, Asia-Pacific: 29%, Latin America: 7% and Middle East & Africa: 7%

Research Coverage:

The report analyzes the Healthcare EDI market and aims at estimating the market size and future growth potential of this market based on various segments such as product & services, transaction type, delivery mode, end user, and region. The report also includes competitive analysis of the key players in this market along with their company profiles, product and service offerings, recent developments, and key market strategies.

Reasons to Buy the Report

The report can help established firms as well as new entrants/smaller firms to gauge the pulse of the market, which, in turn, would help them garner a greater share. Firms purchasing the report could use one, or a combination of the below mentioned five strategies.

This report provides insights into the following pointers:

  • Market Penetration: Comprehensive information on the product portfolios of the top players in the Healthcare EDI market. The report analyzes the market based on the product, type, application, end user, and region.
  • Product Development/Innovation: Detailed insights on upcoming technologies, research and development activities, and product launches in the Healthcare EDI market.
  • Market Development: Comprehensive information about lucrative emerging markets. The report analyzes the markets for various types of Healthcare EDI solutions across regions.
  • Market Diversification: Exhaustive information about products, untapped regions, recent developments, and investments in the Healthcare EDI market.
  • Competitive Assessment: In-depth assessment of market shares, strategies, products, distribution networks, and manufacturing capabilities of the leading players in the Healthcare EDI market.

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Table Of Contents

1 Introduction
1.1 Objectives Of The Study
1.2 Market Definition
1.3 Market Scope
1.3.1 Inclusions And Exclusions
1.3.2 Markets Covered
Figure 1 Healthcare Edi Market Segmentation
1.3.3 Years Considered For The Study
1.4 Limitations
1.5 Currency
1.6 Stakeholders
1.7 Summary Of Changes

2 Research Methodology
2.1 Research Data
Figure 2 Research Design
2.1.1 Secondary Data
2.1.1.1 Key Data From Secondary Sources
2.1.2 Primary Data
Figure 3 Primary Sources
2.1.2.1 Key Data From Primary Sources
2.1.2.2 Breakdown Of Primary Sources
Figure 4 Breakdown Of Primary Interviews: By Company, Designation, And Region
2.2 Market Size Estimation
Figure 5 Market Size Estimation: Revenue Share Analysis
Figure 6 Illustrative Example Of Optum
Figure 7 Top-Down Approach
Figure 8 Cagr Projections: Supply-Side Analysis
2.3 Market Breakdown And Data Triangulation
Figure 9 Data Triangulation Methodology
2.4 Market Share Estimation
2.5 Assumptions For The Study
2.6 Covid-19 Health Assessment
2.7 Covid-19 Economic Assessment
2.8 Assessment Of The Impact Of Covid-19 On The Economic Scenario
Figure 10 Criteria Impacting The Global Economy
Figure 11 Recovery Scenario Of The Global Economy
2.9 Assessment Of The Impact Of Covid-19 On The Economic Scenario Pertaining To The Healthcare Edi Market

3 Executive Summary
Figure 12 Healthcare Edi Market, By Product & Service, 2020 Vs. 2025 (Usd Million)
Figure 13 Healthcare Edi Market, By Delivery Mode, 2020 Vs. 2025 (Usd Million)
Figure 14 Healthcare Edi Market, By Transaction Type, 2020 Vs. 2025 (Usd Million)
Figure 15 Healthcare Edi Market, By End User, 2020 Vs. 2025 (Usd Million)
Figure 16 Healthcare Edi Market: Geographic Snapshot

4 Premium Insights
4.1 Healthcare Edi Market Overview
Figure 17 Increasing Adoption Of Healthcare Edi Solutions To Drive Market Growth
4.2 North America: Healthcare Edi Market, By Delivery Mode (2020)
Figure 18 Web- & Cloud-Based Edi To Account For The Largest Share Of The North American Healthcare Edi Market In 2020
4.3 Geographical Snapshot Of The Healthcare Edi Market
Figure 19 China To Witness The Highest Growth In The Healthcare Edi Market From 2020 To 2025

5 Market Overview
5.1 Introduction
5.2 Market Dynamics
Figure 20 Healthcare Edi Market: Drivers, Restraints, Opportunities, And Challenges
5.2.1 Key Market Drivers
5.2.1.1 Favorable Regulations For Transaction Processes
5.2.1.2 Rising Need To Curtail Healthcare Costs
Figure 21 Healthcare Edi Spending On Claims-Related Business Transactions
5.2.1.3 Government Support For Hcit
Table 1 Impact Analysis: Market Drivers
5.2.2 Market Restraints
5.2.2.1 Data Security-A Major Concern For Patients And Edi Users
5.2.2.2 High Implementation Cost Of Edi Software
Table 2 Impact Analysis: Market Restraints
5.2.3 Market Opportunities
5.2.3.1 Increase In Outsourcing Of Edi Services
5.2.3.2 Introduction Of Icd-11 Guidelines
Table 3 Impact Analysis: Market Opportunities
5.2.4 Market Challenges
5.2.4.1 Integration Between Various Hcit Solutions Within The Healthcare Industry
5.2.4.2 End-User Limitations And Requirements
Table 4 Impact Analysis: Market Challenges
5.3 Covid-19 Impact Analysis
5.3.1 Impact Of Covid-19 On The Healthcare Edi Market
Figure 22 Impact Of Covid-19 On The Healthcare Edi Market
5.4 Ecosystem
Figure 23 Healthcare Edi Market: Ecosystem
5.5 Technology Analysis
Figure 24 Focus On Edi In Healthcare Manufacturing & Distribution And Ipaas Are The Major Trends In The Market

6 Industry Insights
6.1 Evolution Of Edi
Figure 25 Evolution Of Healthcare Edi
6.2 Healthcare Edi Standards
6.2.1 Ansi X12
6.2.2 Edifact
6.2.3 Others
Table 5 Healthcare Edi: Major Transaction Types
6.3 Healthcare Edi And Value-Based Care
Figure 26 Value-Based Care Through Efficient Data Exchange
6.4 Industry Trends
6.4.1 Growing Focus On Integration Platform As A Service (Ipaas)
6.4.2 Increasing Use Of Edi In Healthcare Manufacturing/Distribution
6.4.3 Budgetary Constraints And Cost-Cutting Measures Are Driving The Adoption Of Edi Solutions In European Hospitals

7 Global Healthcare EDI Market, By Product & Service
7.1 Introduction
Table 6 Healthcare Edi Market, By Product & Service, 2018-2025 (Usd Million)
7.2 Services
7.2.1 Increased Demand For Software-As-A-Service (Saas) Offerings And Outsourced Services Is A Major Driving Factor
Table 7 Healthcare Edi Services Offered By Key Market Players
Table 8 Healthcare Edi Services Market, By Country, 2018-2025 (Usd Million)
7.3 Solutions
7.3.1 Healthcare Edi Solutions Are Mostly Used For The Edi Van And Point-To-Point Edi Modes Of Delivery
Table 9 Healthcare Edi Solutions Offered By Key Market Players
Table 10 Healthcare Edi Solutions Market, By Country, 2018-2025 (Usd Million)

8 Global Healthcare EDI Market, By Delivery Mode
8.1 Introduction
Table 11 Healthcare Edi Market, By Delivery Mode, 2018-2025 (Usd Million)
8.2 Web- & Cloud-Based Edi
8.2.1 Provides An Affordable Solution For Small- And Medium-Sized Healthcare Providers
Table 12 Web- & Cloud-Based Edi Market, By Country,2018-2025 (Usd Million)
8.3 Edi Van
8.3.1 This Delivery Model Is Most Commonly Used By Clearinghouses Or Intermediaries
Table 13 Edi Van Market, By Country, 2018-2025 (Usd Million)
8.4 Point-To-Point Edi
8.4.1 Primarily Used By Large Organizations To Process And Exchange Large Numbers Of Documents
Table 14 Point-To-Point Edi Market, By Country, 2018-2025 (Usd Million)
8.5 Mobile Edi
8.5.1 Mobile Edi Is Expected To Be The Fastest-Growing Segment Owing To The Increased Use Of Mobiles For Data Exchange
Table 15 Mobile Edi Market, By Country, 2018-2025 (Usd Million)

9 Global Healthcare EDI Market, By Transaction Type
9.1 Introduction
Table 16 Healthcare Edi Market, By Transaction Type,2018-2025 (Usd Million)
9.2 Claims Management
Table 17 Claims Management Edi Solutions Offered By Key Market Players
Table 18 Claims Management Edi Market, By Type, 2018-2025 (Usd Million)
Table 19 Claims Management Edi Market, By Country, 2018-2025 (Usd Million)
9.2.1 Claims Submission
9.2.1.1 Growing Adoption Of Electronic Claims Submission Is A Major Driving Factor For Market Growth
Table 20 Claims Submission Edi Solutions Offered By Key Market Players
Table 21 Claims Submission Edi Market, By Country, 2018-2025 (Usd Million)
9.2.2 Claims Status
9.2.2.1 Need To Decrease The Time Spent On Manual Claims Management Is A Major Driving Factor For Market Growth
Table 22 Claims Status Edi Solutions Offered By Key Market Players
Table 23 Claims Status Edi Market, By Country, 2018-2025 (Usd Million)
9.2.3 Eligibility Verification
9.2.3.1 Eligibility Verification Solutions Help Reduce Problems Associated With Paper-Based Systems
Table 24 Eligibility Verification Edi Solutions Offered By Key Market Players
Table 25 Eligibility Verification Edi Market, By Country, 2018-2025 (Usd Million)
9.2.4 Claims Payment
9.2.4.1 Claims Payment Solutions Help Automate Payment Exchange Between Payers And Providers-A Key Factor Driving Market Growth
Table 26 Claims Payment Edi Solutions Offered By Key Market Players
Table 27 Claims Payment Edi Market, By Country, 2018-2025 (Usd Million)
9.2.5 Referral Certification & Authorization
9.2.5.1 Need To Increase Health Plan Investments And Reduce Response Times Are Major Driving Factors For Market Growth
Table 28 Referral Certification & Authorization Edi Solutions Offered By Key Market Players
Table 29 Referral Certification & Authorization Edi Market, By Country, 2018-2025 (Usd Million)
9.2.6 Payment Remittance
9.2.6.1 Growing Demand For Streamlining Payment Information For Health Insurance Is A Major Driving Factor
Table 30 Payment Remittance Edi Solutions Offered By Key Market Players
Table 31 Payment Remittance Edi Market, By Country, 2018-2025 (Usd Million)
9.2.7 Other Edi Transactions
Table 32 Other Edi Transactions Market, By Country, 2018-2025 (Usd Million)
9.3 Healthcare Supply Chain Management
9.3.1 Major Driving Factors Are Increased Efficiency And Accuracy, Better Supply Chain Integration, And Improved Inventory Management
Table 33 Healthcare Supply Chain Management Edi Solutions Offered By Key Market Players
Table 34 Healthcare Supply Chain Management Edi Market, By Country, 2018-2025 (Usd Million)

10 Global Healthcare EDI Market, By End User
10.1 Introduction
Table 35 Healthcare Edi Market, By End User, 2018-2025 (Usd Million)
10.2 Healthcare Providers
10.2.1 Edi Solutions Help In The Exchange Of Patient Information And Intelligent Clinical Decision Support Among Providers & Payers
Table 36 Healthcare Edi Market For Healthcare Providers, By Country, 2018-2025 (Usd Million)
10.3 Healthcare Payers
10.3.1 Increase In The Number Of Private Insurers To Drive The Market For Healthcare Edi Solutions
Table 37 Healthcare Edi Market For Healthcare Payers, By Country, 2018-2025 (Usd Million)
10.4 Medical Device & Pharmaceutical Companies
10.4.1 Edi Solutions Help Synchronize Business Processes And Improve The Efficiency Of Supply Chain Management
Table 38 Healthcare Edi Market For Medical Device & Pharmaceutical Companies, By Country, 2018-2025 (Usd Million)
10.5 Pharmacies
10.5.1 Edi Solutions Help Reduce The Overall Costs And Human Typing Errors In Pharmacies
Table 39 Healthcare Edi Market For Pharmacies, By Country, 2018-2025 (Usd Million)

11 Global Healthcare EDI Market, By Region

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