The global healthcare payer services market is anticipated to grow at a considerable CAGR of 7.8% during the forecast period (2024-2031). Claim management services is one of the major types of healthcare payer services, which has witnessed a significant increase in demand. These kind of services are in demand owing to the presence of associate chartered accountants (ACA) coupled with the increasing overall healthcare expenditure. These are some of the crucial factors that are driving the number of members enrolled in the Centers for Medicare and Medicaid Services (CMMS). According to the CMMS, an estimated 60 million individuals (18.2% of the US population) were enrolled in Medicare in 2021. The program accounted for $901 billion (22.3% of overall health consumption expenditures); this share is about 11.0% points higher than Medicare’s percentage of health consumption expenditures in 1970. In 2021, most of the spending was for hospital care and physician and professional services.
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Most of the payer workload is composed of claims processing services, which are the most data-intensive operations. The claims that providers submit are examined for qualifying requirements, veracity, and the precise amount that must be paid back. Due to the introduction of the digital era, the method has been streamlined and processing times have decreased significantly. For instance, in October 2021, blue shield of California, google cloud collaborated to transform medical billing by bringing real time reimbursement information to providers. Blue Shield and Google Cloud launched a new approach to paying providers that processed members’ claims in real time. By developing a scalable cloud platform that integrated solutions from Blue Shield’s other technology partners, the companies digitized health care claims using automated processing, artificial intelligence, and machine learning technologies to greatly improve the accuracy and timeliness of billing information and claims payment.
Furthermore, according to the study published in the Journal of Medical Internet Research, titled ‘Combating Health Care Fraud and Abuse: Conceptualization and Prototyping Study of a Blockchain Antifraud Framework’ in September 2020, an estimated $2.6 billion loss is attributed to health care fraud and abuse. With traditional health care claims verification and reimbursement, the health care provider submitted a claim after rendering services to a patient, which is then verified and reimbursed by the payer. Such incidences will lead to increased adoption of claim management services, driving the market growth over the forecast period.
Global Healthcare Payer Services Market Report Segment
By Services
- Business Process Outsourcing (BPO) Services
- Knowledge Process Outsourcing (KPO) Services
- Information Technology Outsourcing (ITO) Services
By End-Use
- Private Payers
- Public Payers
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Global Healthcare Payer Services Market Report Segment by Region
North America
- United States
- Canada
Europe
- UK
- Germany
- Italy
- Spain
- France
- Rest of Europe
Asia-Pacific
- China
- India
- Japan
- South Korea
- Rest of Asia-Pacific
Rest of the World
- Latin America
- Middle East & Africa
Company Profiles
- Allscripts Healthcare, LLC
- Cognizant Technology Solutions Corp.
- Concentric Corp.
- Conduent Inc.
- Conifer Health Solutions, LLC
- EXL Service Holdings, Inc.
- Firstsource Solutions Ltd.
- Genpact
- HCL Technologies Ltd.
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