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The rising shift towards the use of automated data validation with artificial intelligence (AI), cloud-based EDI solutions, the expansion of API-based plug-ins, and the increased adoption of blockchain technology to enhance security are expected to bolster the growth of the healthcare EDI market. Moreover, to promote health data interoperability, the 2020 Cures Act Final Rule from ONC enforced important 21st Century Cures Act provisions, such as the ban on information blocking, which is expected to provide growth opportunities for vendors offering healthcare EDI market. The cloud-based EDI solutions are gaining popularity due to their cost-effectiveness, flexibility, scalability, and improved security over traditional on-premises EDI solutions. In addition, real-time data exchange, reduced IT hassle, integration, and quick deployment are some other factors contributing to cloud-based EDI solutions' highest growth.
By transaction type, the claims management software segment is expected to grow at the highest CAGR during the forecast period. The growth of this segment can be attributed to an increased volume of healthcare claims, the intricacy of healthcare billing and regulatory requirements, and the need for a decrease in errors and claim denials.
The software segment is expected to hold a significant share of the healthcare EDI market by component. Healthcare providers and payers can automate their workflows by decreasing administrative costs, reducing errors, and enhancing data security with the effective utilization of healthcare EDI software. The seamless integration of software, real-time data exchange, and automation in healthcare transactions are some of the major factors driving market growth.
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Key players in the healthcare EDI market are McKESSON CORPORATION (US), UnitedHealth Group Incorporated (US), Cognizant (US), IBM (US), Veradigm LLC (US), athenahealth (US), Axway (US), Boomi (US), and True Commerce, Inc. (US) among others.
These market players have offered a diverse range of products and services and have operations worldwide. They rely on technological advancements to avail themselves of innovative products and services and increase their global footprint. These players focus on acquisitions, collaborations, agreements, mergers, product launches & updates, partnerships, expansions, and other recent developments to expand their global reach and develop advanced EDI solutions.
McKESSON CORPORATION:
McKesson CORPORATION provides software and services used in pharmacy services, specialty practices, biopharma, pharmaceutical distribution, and medical supplies and equipment. The company has a strong foothold in the US, from where it generated more than 90% share of its revenue. The company provides claims management and supply management software and services. It adopted acquisitions and product approvals as critical strategies to increase its revenue. The company's supply management offerings provide data exchange tools that streamline pharmacy operations by managing product data for pricing updates, purchase orders, invoicing, and customization for specific customer needs. Their claims management solution offers claims processing and supports various plan types like Medicaid, Medicare, FIDA, dual-eligibility services, and automated electronic payments.
UnitedHealth Group Incorporated:
UnitedHealth Group is a healthcare company that offers healthcare products and insurance services. The company caters to a broad range of healthcare providers, such as hospitals, doctors, pharmacies, health plan organizations, and life science companies. Through Optum, the company provides integrated claims management software designed explicitly for eligibility and referrals, prior authorization, claims status, and reconsideration. The company has created a significant footprint in the healthcare services industry through investments in digital health innovations and collaborations with healthcare providers.
Cognizant
Cognizant has a strong geographical footprint across North America and Europe, from where it generated more than 90% share of its revenue. Cognizant offers claims management software that simplifies the process of handling EDI for healthcare payers. With EDI consolidation functionality, it consolidates all interactions into one efficient system instead of managing multiple connections.
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