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Medical Claims Processing Services Market Demands and Growth Prediction, Outlook 2018-2026

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As the global healthcare industry continues to expand, healthcare providers are facing challenges in maintaining optimal quality of services. Number of claims are increasing with increasing coverage of medical insurance. Processing such claims along
Medical Claims Processing Services Market
Widespread Research and Fundamental study to
2026
Medical Claims Processing Services Market – Global Industry Insights, Trends,
Outlook, and Opportunity Analysis, 2018-2026
Medical Claims Processing Services
As the global healthcare industry continues to expand, healthcare providers are facing challenges in
maintaining optimal quality of services. Number of claims are increasing with increasing coverage of
medical insurance. Processing such claims along with the administrative tasks, patient care, and other
daily operations is cumbersome and involves high cost and trained personnel. Processing of claims inhouse by the healthcare provider has the risk of delayed payment, error in amounting, and customer
dissatisfaction. Moreover, healthcare providers need to be updated with changes in regulations and new
services and products being launched in the market for in-house processing of claims.
Outsourcing of medical claims ensures minimal error and faster turnover, thereby reducing risk of
delayed payment. According to the American Medical Association (AMA), 20% error rate among
health insurers represents an intolerable level of inefficiency that causes a loss of around US$ 17 billion
each year. This depicts a strong need for adequate and technically advanced claim processing services
and software to reduce the economic burden.
Earlier, claims were submitted using a paper form. However, with the advent of healthcare IT, most
claims are now electronically made i.e. electronic data interchange. The onset of online medical claim
process reduces paperwork of healthcare providers and also assists in rendering adequate fees for the
services. Usually the medical claims are processed by medical claims examiners or medical claims
adjusters. In case of large number of claims though, medical directors review the claim and validate its
authenticity.
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The medical claims processing services market can be analyzed for:
•Claim indexing
•Claim investigation
•Claim adjudication
•Claim repricing
•Claim settlement
•Litigation management and
•Information management services
Most of these services are either directly rendered by the service provider or can be outsourced to thirdparty organizations for code assignment and claim processing. Outsourcing concept reduces the burden
as well as cost for insurance companies. Most billing services charge a percentage of the collected
claim amount. The concept of EMR/EHR has also streamlined claim processing, as patient records are
electronically transmitted to the billing service providers, which eliminates the process of recording and
sending paper-based records.
Medical Claims Processing Services Industry Outlook is Positive in Developed Economies
According to Swiss Re, the global insurance penetration rate was a mere 6.2% in 2014, with India
having insurance penetration rate on the lower side, at just 3.9% in the same year. Moreover, the study
found that the insurance penetration rate fell to 3.2% in 2015 in India. The U.S., Japan, U.K., Australia,
Italy, and France are some of the leading countries in the global medical claims processing services
market, owing to higher insurance penetration rate, increasing number of claims, and growing demand
from healthcare providers. Furthermore, favorable healthcare policy and government initiatives such as
Affordable Care Act have also boosted demand for medical claim processing services in the U.S.
Europe is quickly emerging as another important Medical Claims Processing Services Market.
Although the medical claims processing services market in Asia Pacific and Rest of the World are still
at a very nascent stage, high population base and increasing awareness for insurance in the middle
income group is expected to boost demand for medical claim processing services in the near future.
Medical Claims Processing Services Market Competitive Landscape
Some of the prominent players in the global medical claims processing services market include Aetna
Inc., Infinit Healthcare, Invensis Technologies Pvt. Ltd, Humana Inc., UnitedHealth Group, Telegenisys
Inc., and Health Care Service Corp.
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