Dublin, April 17, 2025 (GLOBE NEWSWIRE) -- The "Healthcare EDI Market by Transmission (Value Added Network, Point-to-Point), Software (Claims (Submission, Status, Payment, Referral, Remittance), Supply (Procurement, Inventory), Service, End User (Hospital, ASC, Payer), Region - Global Forecast to 2029" has been added to ResearchAndMarkets.com's offering.
The global Healthcare EDI market is projected to reach USD 7.11 billion by 2029 from USD 4.47 billion in 2024, reflecting a CAGR of 9.7% from 2024 to 2029. This growth is driven by the rapid digitization of healthcare records, regulatory compliance demands, increasing claims submissions, and cost efficiency benefits.
The Workgroup for Electronic Data Interchange (WEDI) highlights potential savings for various healthcare players across the US, with EDI implementation potentially saving USD 1 per claim for health plans and insurers, USD 1.49 for physicians, USD 0.86 for hospitals, and USD 0.83 for other parties. The CAQH Index 2023 reported an 8% surge in claim submissions, reaching 9.5 billion in 2023 in the US. Challenges such as system integration, data privacy, and security concerns persist.
Point-to-point EDI Dominates the Market
The healthcare EDI market is divided by transmission type into Value Added Network (VAN) EDI and point-to-point EDI. In 2023, the point-to-point EDI segment, offering greater control and security over data, captured the largest market share. This type of EDI facilitates direct data exchange between partners, often utilized by healthcare organizations for secure and regulatory-compliant data transactions, despite challenges like interoperability and setup complexities.
Claims Payment Segment on the Rise
By transaction type, the healthcare EDI market includes claims submission, claims status, eligibility verification, claims payment, and others. The claims payment segment is anticipated to be the fastest-growing, driven by the need for automated, efficient payment systems and potential annual cost savings of USD 524 million from fully electronic claim payments as reported by the CAQH Index 2023. This segment's growth is propelled by the demand for swift claims adjudication and increasing complexity in reimbursement models.
Asia Pacific Leads in Growth
Among the geographical segments, Asia Pacific is expected to record the highest CAGR. Key drivers include expanding healthcare infrastructure, government efforts towards digitization, and a flourishing health insurance sector. Countries like China and Japan emphasize real-time public health data sharing and healthcare data standardization, with initiatives such as the Healthy China 2030 Plan underpinning these changes. Additional factors like medical tourism, rising healthcare expenditure, and enhanced insurance penetration also contribute.
Industry Insights from Supply-side Interviews
Supply-side interviews reveal a breakdown by company type with Tier 1 companies at 40%, Tier 2 at 35%, and Tier 3 at 25%. Designations include managers (40%), directors (35%), and others (25%), with the regional spread as follows: North America (40%), Europe (30%), Asia Pacific (20%), Latin America (5%), and Middle East & Africa (5%).
Leading Companies Profiled
The report profiles major players such as McKESSON CORPORATION, UnitedHealth Group, IBM, Cognizant, and many others across the US, Japan, and Poland. These companies are analyzed for their business strategies, market offerings, and technological innovations.
Research Coverage
The report categorizes the healthcare EDI market by components, transmission type, end users, and regions. It provides an extensive analysis of market drivers, challenges, and opportunities, ensuring stakeholders a comprehensive understanding of the competitive landscape and potential strategies for market entry and expansion.
Key Intelligence Insights Major insights include:
- Analysis of market dynamics: drivers such as regulatory compliance, cost reduction, and claims management advancements; challenges include data security and system interoperability.
- Product Innovation: Insights into new technologies, R&D activities, and product launches.
- Market Expansion: Analysis of lucrative regions for expansion.
- Market Diversification: Insights on new products, geographic opportunities, and recent market activities.
- Competitive Assessment: Evaluation of market shares and strategies of leading organizations such as McKESSON, UnitedHealth Group, Cognizant, and IBM in the healthcare EDI sector.
Key Attributes:
| Report Attribute | Details |
| No. of Pages | 368 |
| Forecast Period | 2024 - 2029 |
| Estimated Market Value (USD) in 2024 | $4.47 Billion |
| Forecasted Market Value (USD) by 2029 | $7.11 Billion |
| Compound Annual Growth Rate | 9.7% |
| Regions Covered | Global |
Key Topics Covered:
Drivers
- Supportive Regulations for Transaction Processes
- Growing Requirement to Curb Healthcare Costs
- Healthcare Edi Software Provides Low Costs and Improved Operational Efficiency
- Increasing Demand for Streamlined Claims Management
- Acceleration of Claims Management with API Integration
Restraints
- Concerns Associated with Data Security
- High Software Implementation Costs
Opportunities
- Rising Trend of Outsourcing Edi Services
- Adoption of Icd-11 Guidelines
- Benefits of Real-Time Data Exchange
- Expansion of Telehealth and Remote Monitoring Capabilities
Challenges
- Integration of Healthcare IT Solutions
- End-user Limitations & Requirements
- Interoperability Issues in Legacy Systems
- Complexities Associated with Transactions
Case Studies
- Transforming Claims Management with Optum Claims Manager
- Use Case 1: Optum Claims Manager Enhances Revenue Management & Compliance for North Carolina
- Vibra Healthcare's Success with Waystar
- Use Case 2: Streamlining Billing and Enhancing Cost Reduction with Waystar
- Enhancing Pharmacy Claims Efficiency with Relayrx
- Use Case 3: Streamlining Pharmacy Reimbursements and Improving Patient Outcomes
Industry Trends
- Adoption of Interoperability Standards
- Growth of Value-based Care Models
- Increasing Emphasis on Data Security & Privacy
- Growing Focus on Integration Platform as a Service (Ipaas)
- Increasing Use of Edi in Supply Chain & Distribution Industry
Company Profiles
- Mckesson Corporation
- Unitedhealth Group
- Cognizant
- IBM
- Veradigm LLC
- Athenahealth, Inc.
- Boomi, Lp
- Experian Information Solutions, Inc.
- Ssi Group LLC
- Quadax, Inc.
- Waystar
- Availity, LLC
- Comarch SA
- Axway
- Plexis Healthcare Systems
- True Commerce, Inc.
- Inovalon
- 123 Edi
- Ntt Data Group Corporation
- Cirius Group, Inc.
- Epicor Software Corporation
- Osp Labs
- Nalashaa
- Wns
- Pilotfish, Inc.
- Cleo
For more information about this report visit https://www.researchandmarkets.com/r/1w6vbr
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