Healthcare EDI Market

Healthcare EDI Market by Component (Solution, Service), Delivery Mode (On-premise & Cloud, Mobile) Transaction Type (Claims Management, Payment Remittance, Payments, Healthcare Supply Chain), End-User - Global Forecast to 2025

Report Code: HIT 2464 Dec, 2020, by marketsandmarkets.com

[ 195 Pages Report] 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 growth of this market is majorly attributed to the development of regulations for transaction processes, the rising need to curtail healthcare costs, and government support for HCIT implementation. In addition, the need for the efficient management of electronic claims and reimbursement transactions for healthcare providers are expected to drive demand growth in the healthcare EDI market during the forecast period. 

Attractive Opportunities In The Healthcare EdI Market

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Covid-19 Impact on the Healthcare EDI Market

The current COVID-19 pandemic has resulted in a massive number of patients visiting healthcare facilities on a daily basis. According to WHO data, there were 62.3 million confirmed COVID-19 cases and 1.4 million deaths globally, as of November 30, 2020. Due to the COVID-19 outbreak, the number of patient data globally has increased. With the COVID-19 pandemic, most countries, including the whole of Europe, the US, India, and Australia, among others, are following complete nationwide lockdowns. These lockdowns and restrictions related to social distancing have also led to an increase in the use of healthcare EDI solutions that help in exchanging patient data between healthcare providers and payers. 

Driver: Regulations for transaction processes

The Healthcare Insurance Portability and Accountability Act (HIPAA), passed in 1996, set up a standard for the transmission of insurance data. Prior to this act, there were 400 different medical form standards that not only made it difficult for providers and payers to process claims but also introduced many errors that made it important to implement a standard for claims management. EDI has eased the process of claims management, with the entire process being conducted electronically with software that meets the needs of HIPAA for electronic filing. The Patient Protection and Affordability Care Act, also known as the Obamacare Act, was passed in 2010 in the US The Act aimed at increasing the affordability and quality of health insurance and mandated the 834 EDI transaction for healthcare providers and payers. Its purpose is to electronically transmit enrollment and dis-enrollment information. This step is a major reason driving the adoption of EDI in the healthcare industry in the US. 

Restraint: High implementation cost of EDI software

Although the adoption of healthcare EDI by healthcare providers is on the rise, the cost associated with EDI software installation is high. The major reason for this includes third-party solutions and inadequate internal systems and clearinghouses adding high costs per transaction with expensive setup fees. This will significantly affect the total cost of ownership. In developed markets across Europe and North America, the acceptance for EDI solutions has been lower among small- and medium-sized healthcare providers mainly due to the relatively high investments required for the implementation of EDI. Many small- and medium-sized healthcare providers regard tangible costs of implementation of EDI to exceed the tangible benefits, which prevents them from implementing EDI solutions. 

Opportunity: Increase in outsourcing of EDI services

EDI outsourcing is the process of having a third party manage a part or the entire process of using EDI to exchange data with trading partners. Growing healthcare costs are increasingly pressurizing in the healthcare industry to provide quality care at lower costs by minimizing wastages at each stage. Healthcare revenue loss in American hospitals due to self-pay billing issues is as high as 20% to 30%. Additionally, according to a Ponemon Institute survey in 2014, of 577 healthcare professionals, the US physicians and hospitals have shown an inability to use the latest mobile devices and internet services to deliver patient care. As a result, US hospitals absorb an estimated USD 8.3 billion annually, while struggling with security and privacy concerns arising from the mainstreaming of social media at a time when federal rules allow for steep fines when it comes to violating patient privacy. For hospitals, this makes the outsourcing of billing and claim services to EDI service providers an attractive proposition. 

Challenge: End-user limitations and requirements

Despite its long-term benefits, EDI has witnessed limited success. The reason for this lies in the nature of the hospitals that use healthcare EDI and the healthcare organizations that require it. The demand side/end users are participants who are relatively small, have limited IT resources, and suffer from limited financial strength; this prevents them from adopting EDI. Unlike the retail world, in healthcare, large suppliers mandate the use and adoption of healthcare EDI. While these large vendors have the resources and budgets necessary to deploy and use healthcare EDI, the hospitals and facilities they deal with are often cash-strapped and have limited IT resources, making the adoption of healthcare EDI precarious and time-consuming. This problem of lack of resources, with mandates for solution implementation, means that finding healthcare EDI solutions that are viable can be challenging.

By delivery mode, mobile EDI segment is expected to grow at the highest growth rate during the forecast period

Among the delivery mode, segment, the mobile EDI segment is expected to grow at the highest CAGR during the forecast period. The factors attributing to the high growth of this segment include the technological upgrades in the healthcare industry and growing acceptance of mobile solutions among healthcare providers. 

By component, the services segment is expected to record the highest CAGR during the forecast period

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 transaction type, the claims management segment is expected to account for the largest share of the healthcare EDI market

On the basis of transaction type, the healthcare EDI market is segmented into claims management and healthcare supply chain. The claims management segment is expected to account for the largest share of the healthcare EDI market during the forecast period. The large share of this segment can be attributed to the rising adoption of EDI services by healthcare providers and payers and the need to meet regulatory requirements. 

By end user, the healthcare payers segment to record the highest CAGR 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. 

Healthcare EDI Market By Region

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Asia-Pacific is the fastest growing market for healthcare EDI market during the forecast period 

Asia-Pacific is expected to grow at high CAGR during the forecast period. Increasing incidence of chronic diseases and the rising geriatric population, growing demand for advanced healthcare systems due to increasing per capita disposable incomes in the region, and growing awareness of healthcare EDI solutions among healthcare providers and payers are responsible for the high CAGR of the Asia-Pacific healthcare EDI market. 

Key Market Players

The major players in the global Healthcare EDI market are McKesson Corporation (US), Optum (US), Allscripts Healthcare Solutions Inc. (US), athenahealth (US), and Nextgen Healthcare (US). 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). 

Scope of the Report:

Report Metric

Details

Market size available for years

2018–2024

Base year considered

2019

Forecast period

2020–2025

Forecast units

Value (USD Billion)

Segments covered

Component, transaction type, delivery mode, end user and region

Geographies covered

North America, Europe, Asia, Latin America, and Middle East & Africa

Companies covered

McKesson Corporation (US), Optum (US), Allscripts Healthcare Solutions Inc. (US), athenahealth (US), Nextgen Healthcare (US), 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 research report categorizes the Healthcare EDI market into the following segments and sub segments:

Component

  • Services
  • Solutions

Transaction Type

  • Claims Management
    • Claims Submission
    • Claim Status
    • Eligibility Verification
    • Payment Remittance
    • Referral Certification & Authorization
    • Claim Payments
    • Others
  • Healthcare Supply Chain

Delivery Mode

  • Web & Cloud-based EDI
  • EDI VAN
  • Point-to-Point EDI
  • Mobile EDI

End-User

  • Healthcare Providers
  • Healthcare Payers
  • Medical Device & Pharmaceutical Industries
  • Pharmacies

Region

  • North America
    • US
    • Canada
  • Europe
    • Germany
    • UK
    • France
    • Italy
    • Spain
    • Rest of Europe
  • Asia Pacific
    • China
    • Japan
    • India
    • Rest of Asia Pacific
  • Latin America
  • Middle East and Africa

Recent Developments 

  • In 2020, SSI Group partnered with RCxRules to launch HCC Coding Edit Suite
  • In 2020, Waystar Health launched the Waystar Analytics software
  • In 2020, Waystar Health acquired eSolutions 

Frequently Asked Questions (FAQ):

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TABLE OF CONTENTS
 
1 INTRODUCTION (Page No. - 25)

    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 (Page No. - 30)
    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 (Page No. - 43)
  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 (Page No. - 47)
    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 (Page No. - 50)
    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 (Page No. - 59)
    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 (Page No. - 65)
    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 (Page No. - 70)
    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 (Page No. - 76)
    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 (Page No. - 90)
     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 (Page No. - 96)
     11.1 INTRODUCTION
          TABLE 40 HEALTHCARE EDI MARKET, BY REGION, 2018-2025 (USD MILLION)
     11.2 NORTH AMERICA
          FIGURE 27 NORTH AMERICA: HEALTHCARE EDI MARKET SNAPSHOT
          TABLE 41 NORTH AMERICA: HEALTHCARE EDI MARKET, BY COUNTRY, 2018-2025 (USD MILLION)
          TABLE 42 NORTH AMERICA: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
          TABLE 43 NORTH AMERICA: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
          TABLE 44 NORTH AMERICA: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
          TABLE 45 NORTH AMERICA: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION)
          TABLE 46 NORTH AMERICA: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)
            11.2.1 US
                     11.2.1.1 US has the highest healthcare expenditure among OECD nations
                              TABLE 47 US: KEY MACROINDICATORS
                              TABLE 48 US: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
                              TABLE 49 US: HEALTHCARE EDI MARKET, BY DELIVERY MODE,2018-2025 (USD MILLION)
                              TABLE 50 US: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
                              TABLE 51 US: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION)
                              TABLE 52 US: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)
            11.2.2 CANADA
                     11.2.2.1 Major challenges faced in the management of patient data promote the demand for healthcare EDI solutions
                              TABLE 53 CANADA: KEY MACROINDICATORS
                              TABLE 54 CANADA: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
                              TABLE 55 CANADA: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
                              TABLE 56 CANADA: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
                              TABLE 57 CANADA: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION) 106
                              TABLE 58 CANADA: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION) 106
     11.3 EUROPE
          TABLE 59 EUROPE: HEALTHCARE EDI MARKET, BY COUNTRY, 2018-2025 (USD MILLION)
          TABLE 60 EUROPE: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
          TABLE 61 EUROPE: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
          TABLE 62 EUROPE: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
          TABLE 63 EUROPE: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION)
          TABLE 64 EUROPE: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)
            11.3.1 GERMANY
                     11.3.1.1 Need for thorough documentation and record retention requirements by state governments propel the demand for healthcare EDI
                              TABLE 65 GERMANY: KEY MACROINDICATORS
                              TABLE 66 GERMANY: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
                              TABLE 67 GERMANY: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
                              TABLE 68 GERMANY: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
                              TABLE 69 GERMANY: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE,2018-2025 (USD MILLION)
                              TABLE 70 GERMANY: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)
            11.3.2 UK
                     11.3.2.1 Healthcare providers in the UK are focusing on transforming their organizations into paperless environments through EHRs
                              TABLE 71 UK: KEY MACROINDICATORS
                              TABLE 72 UK: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
                              TABLE 73 UK: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
                              TABLE 74 UK: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
                              TABLE 75 UK: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION)
                              TABLE 76 UK: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)
            11.3.3 FRANCE
                     11.3.3.1 Growing initiatives to promote the adoption of healthcare IT solutions to drive market growth
                              TABLE 77 FRANCE: KEY MACROINDICATORS
                              TABLE 78 FRANCE: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
                              TABLE 79 FRANCE: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
                              TABLE 80 FRANCE: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
                              TABLE 81 FRANCE: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION)
                              TABLE 82 FRANCE: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)
            11.3.4 REST OF EUROPE
                   TABLE 83 REST OF EUROPE: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
                   TABLE 84 REST OF EUROPE: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
                   TABLE 85 REST OF EUROPE: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
                   TABLE 86 REST OF EUROPE: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION)
                   TABLE 87 REST OF EUROPE: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)
     11.4 ASIA PACIFIC
          FIGURE 28 ASIA PACIFIC: HEALTHCARE EDI MARKET SNAPSHOT
          TABLE 88 APAC: HEALTHCARE EDI MARKET, BY COUNTRY, 2018-2025 (USD MILLION)
          TABLE 89 APAC: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
          TABLE 90 APAC: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
          TABLE 91 APAC: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
          TABLE 92 APAC: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION)
          TABLE 93 APAC: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)
            11.4.1 JAPAN
                     11.4.1.1 Japan is the largest contributor in the Asia Pacific region
                              TABLE 94 JAPAN: KEY MACROINDICATORS
                              TABLE 95 JAPAN: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
                              TABLE 96 JAPAN: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
                              TABLE 97 JAPAN: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
                              TABLE 98 JAPAN: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION)
                              TABLE 99 JAPAN: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)
            11.4.2 CHINA
                     11.4.2.1 Growing need for better management of healthcare services through an integrated healthcare environment to drive market growth
                              TABLE 100 CHINA: KEY MACROINDICATORS
                              TABLE 101 CHINA: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
                              TABLE 102 CHINA: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
                              TABLE 103 CHINA: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
                              TABLE 104 CHINA: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION)
                              TABLE 105 CHINA: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)
            11.4.3 INDIA
                     11.4.3.1 Growing volume of patient data generated by healthcare systems is a major factor driving the adoption of healthcare EDI solutions
                              TABLE 106 INDIA: KEY MACROINDICATORS
                              TABLE 107 INDIA: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION) 131
                              TABLE 108 INDIA: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
                              TABLE 109 INDIA: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
                              TABLE 110 INDIA: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION)
                              TABLE 111 INDIA: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)
            11.4.4 REST OF ASIA PACIFIC
                   TABLE 112 REST OF ASIA PACIFIC: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
                   TABLE 113 REST OF ASIA PACIFIC: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
                   TABLE 114 REST OF ASIA PACIFIC: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
                   TABLE 115 REST OF ASIA PACIFIC: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION)
                   TABLE 116 REST OF ASIA PACIFIC: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)
     11.5 LATIN AMERICA
            11.5.1 RISING HEALTHCARE EXPENDITURE TO PROVIDE LUCRATIVE GROWTH OPPORTUNITIES FOR PLAYERS OPERATING IN THE MARKET
                   TABLE 117 LATIN AMERICA: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
                   TABLE 118 LATIN AMERICA: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
                   TABLE 119 LATIN AMERICA: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
                   TABLE 120 LATIN AMERICA: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION)
                   TABLE 121 LATIN AMERICA: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)
     11.6 MIDDLE EAST & AFRICA
            11.6.1 INCREASING INVESTMENTS IN MODERNIZING HEALTHCARE SYSTEMS ARE BOOSTING THE MARKET
                   TABLE 122 MIDDLE EAST & AFRICA: HEALTHCARE EDI MARKET, BY PRODUCT & SERVICE, 2018-2025 (USD MILLION)
                   TABLE 123 MIDDLE EAST & AFRICA: HEALTHCARE EDI MARKET, BY DELIVERY MODE, 2018-2025 (USD MILLION)
                   TABLE 124 MIDDLE EAST & AFRICA: HEALTHCARE EDI MARKET, BY TRANSACTION TYPE, 2018-2025 (USD MILLION)
                   TABLE 125 MIDDLE EAST & AFRICA: HEALTHCARE CLAIMS MANAGEMENT MARKET, BY TYPE, 2018-2025 (USD MILLION)
                   TABLE 126 MIDDLE EAST & AFRICA: HEALTHCARE EDI MARKET, BY END USER, 2018-2025 (USD MILLION)

12 COMPETITIVE LANDSCAPE (Page No. - 141)
     12.1 INTRODUCTION
     12.2 MARKET EVALUATION FRAMEWORK
          FIGURE 29 MARKET EVALUATION FRAMEWORK: PARTNERSHIPS, AGREEMENTS, AND COLLABORATIONS WERE THE MOST WIDELY ADOPTED STRATEGIES
     12.3 MARKET SHARE ANALYSIS
          FIGURE 30 VALUE-BASED MARKET SHARES OF KEY PLAYERS, 2019
     12.4 HEALTHCARE EDI MARKET: GEOGRAPHICAL ASSESSMENT
          FIGURE 31 GEOGRAPHIC ASSESSMENT OF THE KEY PLAYERS IN THE HEALTHCARE EDI MARKET (2019)
     12.5 HEALTHCARE EDI MARKET: R&D EXPENDITURE
          FIGURE 32 R&D EXPENDITURE OF THE KEY PLAYERS IN THE HEALTHCARE EDI MARKET (2019)
     12.6 PRODUCT MATRIX: HEALTHCARE EDI MARKET
     12.7 COMPETITIVE BENCHMARKING
            12.7.1 PRODUCT PORTFOLIO ANALYSIS OF MAJOR PLAYERS IN THE HEALTHCARE EDI MARKET (25 PLAYERS)
            12.7.2 BUSINESS STRATEGIES ADOPTED BY MAJOR PLAYERS IN THE HEALTHCARE EDI MARKET (25 PLAYERS)
     12.8 COMPETITIVE SCENARIO
            12.8.1 KEY DEVELOPMENTS IN THE HEALTHCARE EDI MARKET
                   TABLE 127 PARTNERSHIPS & COLLABORATIONS (2017-2020)
            12.8.2 KEY PRODUCT LAUNCHES
                   TABLE 128 PRODUCT LAUNCHES (2017-2020)
            12.8.3 KEY ACQUISITIONS
                   TABLE 129 ACQUISITIONS (2017-2020)

13 COMPANY EVALUATION MATRIX AND COMPANY PROFILES (Page No. - 150)
     13.1 COMPANY EVALUATION MATRIX DEFINITION & METHODOLOGY
     13.2 COMPANY EVALUATION MATRIX
            13.2.1 STARS
            13.2.2 EMERGING LEADERS
            13.2.3 PERVASIVE PLAYERS
            13.2.4 PARTICIPANTS
                   FIGURE 33 HEALTHCARE EDI MARKET (GLOBAL) COMPETITIVE LEADERSHIP MAPPING, 2019
     13.3 COMPANY PROFILES
(Business Overview, Products & Services Offered, Recent Developments, and MnM View)*
            13.3.1 MCKESSON CORPORATION
                   FIGURE 34 MCKESSON CORPORATION: COMPANY SNAPSHOT (2020)
            13.3.2 OPTUM, INC. (A SUBSIDIARY OF UNITEDHEALTH GROUP INC.)
                   FIGURE 35 OPTUM, INC.: COMPANY SNAPSHOT (2019)
            13.3.3 ATHENAHEALTH, INC. (A VERITAS CAPITAL COMPANY)
            13.3.4 ALLSCRIPTS HEALTHCARE SOLUTIONS, INC.
                   FIGURE 36 ALLSCRIPTS HEALTHCARE SOLUTIONS INC.: COMPANY SNAPSHOT (2019)
            13.3.5 NEXTGEN HEALTHCARE INFORMATION SYSTEMS, LLC
                   FIGURE 37 NEXTGEN HEALTHCARE INFORMATION SYSTEMS, LLC: COMPANY SNAPSHOT (2020)
            13.3.6 EXPERIAN PLC
                   FIGURE 38 EXPERIAN PLC: COMPANY SNAPSHOT (2020)
            13.3.7 COGNIZANT TECHNOLOGY SOLUTIONS CORPORATION
                   FIGURE 39 COGNIZANT TECHNOLOGY SOLUTIONS CORPORATION: COMPANY SNAPSHOT (2019)
            13.3.8 CERNER CORPORATION
                   FIGURE 40 CERNER CORPORATION: COMPANY SNAPSHOT (2019)
            13.3.9 SYNNEX CORPORATION
                   FIGURE 41 SYNNEX CORPORATION: COMPANY SNAPSHOT (2019)
            13.3.10 DELL TECHNOLOGIES INC.
                   FIGURE 42 DELL TECHNOLOGIES INC.: COMPANY SNAPSHOT (2019)
            13.3.11 SSI GROUP LLC
            13.3.12 WAYSTAR HEALTH COMPANY
            13.3.13 COMARCH SA
                    FIGURE 43 COMARCH SA: COMPANY SNAPSHOT (2019)
            13.3.14 AXWAY SOLUTIONS
                    FIGURE 44 AXWAY SOLUTIONS: COMPANY SNAPSHOT (2019)
            13.3.15 PLEXIS HEALTHCARE SYSTEMS, INC.
            13.3.16 OTHER COMPANIES
                     13.3.16.1 Amosoft LLC
                     13.3.16.2 B2BGateway.Net
                     13.3.16.3 DiCentral Corporation
                     13.3.16.4 123 EDI
                     13.3.16.5 Quadax, Inc.

*Details on Business Overview, Products & Services Offered, Recent Developments, and MnM View might not be captured in case of unlisted companies.

14 APPENDIX (Page No. - 187)
     14.1 INSIGHTS FROM INDUSTRY EXPERTS
     14.2 DISCUSSION GUIDE
     14.3 KNOWLEDGE STORE: MARKETSANDMARKETS' SUBSCRIPTION PORTAL
     14.4 AVAILABLE CUSTOMIZATIONS
     14.5 RELATED REPORTS
     14.6 AUTHOR DETAILS

This study involved the extensive use of both primary and secondary sources. The research process involved the study of various factors affecting the industry to identify the segmentation types, key players, competitive landscape, key market dynamics, and key player strategies. 

Secondary Research 

The secondary research process involved the widespread use of secondary sources, directories, databases (such as Bloomberg Businessweek, Factiva, and D&B Hoovers), white papers, annual reports, company house documents, investor presentations, and SEC filings of companies. Secondary research was used to identify and collect information useful for the extensive, technical, market-oriented, and commercial study of the Healthcare EDI market. It was also used to obtain important information about the key players and market classification and segmentation according to industry trends to the bottom-most level, and key developments related to market and technology perspectives. A database of the key industry leaders was also prepared using secondary research. 

Primary Research 

In the primary research process, various sources from both the supply and demand sides were interviewed to obtain qualitative and quantitative information for this report. The primary sources from the supply side include industry experts such as CEOs, vice presidents, marketing and sales directors, technology & innovation directors, and related key executives from various key companies and organizations operating in the Healthcare EDI market. The primary sources from the demand side included industry experts, purchase & sales managers, doctors, and personnel from research organizations. Primary research was conducted to validate the market segmentation, identify key players in the market, and gather insights on key industry trends and key market dynamics. 

A breakdown of the primary respondents is provided below: 

Healthcare EDI Market Size

To know about the assumptions considered for the study, download the pdf brochure

Tiers are defined based on a company’s total revenue. As of 2018: Tier 1= >USD 1 billion, Tier 2 = USD 500 million to USD 1 billion, and Tier 3=

Market Size Estimation

The total size of the Healthcare EDI market was arrived at after data triangulation from two different approaches, as mentioned below. 

Approach to calculate the revenue of different players in the Healthcare EDI market

The size of the global Healthcare EDI market was obtained from annual reports, SEC filings, online publications, and extensive primary interviews. A percentage split was applied to arrive at the size of market segments. Further splits were applied to arrive at the size for each sub-segment. These percentage splits were validated by primary participants. The country-level market sizes obtained from the annual reports, SEC filings, online publications, and extensive primary interviews were added up to reach the total market size for regions. By adding up the market sizes for all the regions, the global Healthcare EDI market was derived. 

Approach to derive the market size and estimate market growth

The market size and market growth were estimated through primary interviews on a regional and global level. All responses were collated, and a weighted average was taken to derive a probabilistic estimate of the market size and growth rate.

Data Triangulation

After arriving at the overall market size—using the market size estimation processes explained above—the market was split into several segments and sub-segments. To complete the overall market engineering process and arrive at the exact statistics of each market segment and sub-segment, the data triangulation and market breakdown procedures were employed, wherever applicable. The data was triangulated by studying various factors and trends from both the demand and supply sides. 

Objectives of the Study 

  • To define, describe, and forecast the global Healthcare EDI market by component, transaction type, delivery mode, end-user, and region
  • To provide detailed information about the significant factors influencing the market growth (such as drivers, restraints, opportunities, and challenges)
  • To analyze micromarkets with respect to individual growth trends, prospects, and contributions to the overall Healthcare EDI market
  • To analyze market opportunities for stakeholders and provide details of the competitive landscape for key players
  • To forecast the size of the Healthcare EDI market in four major regions along with their respective key countries (North America, Europe, Asia-Pacific, Latin America, and Middle East & Africa)
  • To profile the key players in the global Healthcare EDI market and comprehensively analyze their core competencies and market shares
  • To track and analyze competitive developments such as product launches, expansions, and R&D activities of the leading players in the Healthcare EDI market.

Available Customizations 

With the given market data, MarketsandMarkets offers customizations as per the company’s specific needs. The following customization options are available for the report: 

Geographic Analysis

  • Further breakdown of the Asia-Pacific Healthcare EDI market into South Korea, New Zealand, and other Southeast Asian countries
  • Further breakdown of the European Healthcare EDI market into Italy, Spain, Belgium, and the Netherlands.
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