Global Healthcare EDI Market Size By Transaction Type (Claim Management, Claim Payment), By End Use (Healthcare Payers, Pharmaceutical Industries), By Deliver Mode (Mobile-based EDI, Cloud-based EDI), By Geographic Scope And Forecast

Healthcare EDI Market Size And Forecast

Healthcare EDI Market size was valued at USD 2.97 Billion in 2022 and is projected to reach USD 5.67 Billion by 2030, growing at a CAGR of 9.6% from 2023 to 2028.

One of the major factors expected to boost the demand for the Healthcare EDI Market is the growing number of regulations for transaction processes, owing to large amounts of data being generated as a result of rising cases of chronic diseases. The growing need to effectively handle electronic claims and reimbursement transactions is further expected to increase the demand for healthcare EDI in the coming years. The Global Healthcare EDI Market report provides a holistic evaluation of the market. The report offers a comprehensive analysis of key segments, trends, drivers, restraints, competitive landscape, and factors that are playing a substantial role in the market.

Global Healthcare EDI Market Definition

Electronic Data Interchange (EDI) is the automatic transfer of data between a service provider and a payer. For providers, it serves with benefits such as quicker processing of information, reduced administrative burden, and avoidance of claim processing delays. EDI enables payers and care providers to send and receive information faster, that too at a lower cost. EDI assists in the management of exchanging patient health information, health insurance processing, and prescription information exchanges. Thus, EDI is essential for the management of data in a variety of medical fields, including regulatory affairs, clinical trials, and insurance data management.

Manual errors are avoided when information is delivered electronically. It helps in reducing manual systems through medical electronic data interchange, thus avoiding manual errors. Thus, the healthcare sector is increasingly approving EDI services in order to speed up the company’s financial challenges and reduce paperwork. It offers reduced manual systems through medical electronic data interchange, thus avoiding manual errors. With the growing need for supply chain management and claims management, demand for Healthcare EDI services technology is expected to increase in the coming years. Insurance, dental and medical patient database management, reimbursement data management, and regulatory and clinical trials are just a few of the applications of the healthcare EDI.

Global Healthcare EDI Market Overview

The healthcare industry, like many others, has undergone dramatic changes, particularly in data processing, which has become increasingly digitized. Huge amounts of highly sensitive data, including such patient medical records, health insurance reimbursements, and health insurance claims, are interchanged between providers and payers in the healthcare industry. As an outcome of the regulations enacted by the Healthcare Insurance Portability and Accountability Act (HIPAA) and the Patient Protection and Affordable Care Act (PPACA), data sharing has shifted from manual to digital processes (ACA).

Prior to HIPAA, data management was more or less manual and paper-based, making it difficult to safeguard sensitive information. Today, trade agreements exchange information electronically via Electronic Data Interchange (EDI). This is a structured mechanism that aids in the decrease of human intervention and enhances the process. One of the major drivers of the Global Healthcare EDI Market is the rising incidence of chronic diseases, which generates significant amounts of information for the institution, which in turn creates demand for the use of the healthcare EDI system.

Furthermore, a rise in the number of end-users such as payers, providers, the pharmaceutical and medical device industries, and others is expected to boost demand for EDI services. COVID-19 has caused massive disruption in the healthcare industry, as an increasing number of people visit healthcare facilities or hospitals on a regular basis. Healthcare facilities, including hospitals and nursing homes, are facing unprecedented difficulties. As an outcome of the COVID-19 epidemic, patient data has increased globally.

The increasing adoption of virtual care has increased the demand for telehealth solutions. Medical billing, urgent care, and the need for operational efficiency are all on the rise. During the pandemic, these aspects increased sales for Healthcare EDI. However, technical issues may result in data loss, and the high cost of EDI software makes it challenging for the poor and rural areas to use this technology due to limited technological advances.

Global Healthcare EDI Market Segmentation Analysis

The Global Healthcare EDI Market Is Segmented On The Basis of Transaction Type, End Use, Deliver Mode, and Geography.

Healthcare EDI Market, By Transaction Type

• Claim Management
• Claim payment
• Claim status
• Eligibility verification
• Claim submission
• Healthcare Supply Chain

Based on Transaction Type, The market is segmented into Claim Management, Claim Payment, Claim Status, Eligibility Verification, Claim Submission, and Healthcare Supply Chain. Due to the rising use of EDI services by healthcare providers, the claim management segment will have the highest share during the projected period. The benefit to care providers is that they can eliminate claim processing days and save money on administrative costs.

Healthcare EDI Market, By End Use

• Pharmaceutical Industries
• Healthcare Providers
• Pharmacies
• Healthcare payers

Based on End Use, The market is segmented into Healthcare Payers, Pharmaceutical Industries, Healthcare Providers, and Pharmacies. During the projection period, the Healthcare Provider segment is projected to be the fastest-growing. Because of growing demands from disease risk assessment, detection, and prevention of fraudulent claims and insurance plans, healthcare payers will hold the highest end-user share in the market across the projected period.

Healthcare EDI Market, By Deliver Mode

• Mobile-based EDI
• Cloud-based EDI
• Point to point EDI

Based on Deliver Mode, The market is segmented into Mobile-based EDI, Cloud-based EDI, and Point to point EDI. The mobile EDI segment is estimated to increase at a higher rate during the forecast period, owing to rising mobile solution acceptance and technical advancements in the medical industry.

Healthcare EDI Market, By Geography

• North America
• Europe
• Asia Pacific
• Rest of the world

On The Basis Of Geography, the Global Healthcare EDI Market is segmented into North America, Europe, Asia- Pacific, and the Rest of the world. North America is predicted to grow the most during the projected period. Because of high HCIT, broad insurance coverage, and rising healthcare supply chain management demand. And because IT companies in that region play an essential importance in a large portion of the North American EDI market.

Key Players

The “Global Healthcare EDI Market” will provide valuable insight with an emphasis on the global market. The major players in the market are Cognizant, Experian Information Solution, ZirMedInc and LLC., McKesson Corporation, and the SSI Group.

Our market analysis also entails a section solely dedicated to such major players wherein our analysts provide an insight into the financial statements of all the major players, along with its product benchmarking and SWOT analysis. The competitive landscape section also includes key development strategies, market share, and market ranking analysis of the above-mentioned players globally.

Key Developments

• May 2021 – Complete HealthCare Solutions, Inc., a market leader in health IT solutions and management, has announced the acquisition of Selent and Associates, Inc.’s healthcare division, Computerized Business Systems and medicalbillingsoftware.com (DBA), a leading Medisoft/EDI healthcare software and support company based in Punta Gorda, Florida.
• March 2021 – HiPaaS Inc., a healthcare technology company that provides AI-powered Healthcare Electronic Data Interchange (EDI) and CMS Fast Healthcare Interoperability Resources (FHIR) Interoperability products, has announced an OEM agreement with Neo4j®, the leader in graph technology, to use its graph database capabilities to help accelerate HiPaaS Electronic Data Interchange (EDI) and Interoperability implementations.
• February 2021 – BJC HealthCare (BJC), a long-standing client of Prodigo Solutions, has “gone live” on Xchange, a private B2B commerce network for automating electronic data interchange (EDI) and other electronic transactions between business associates.

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• Qualitative and quantitative analysis of the market based on segmentation involving both economic as well as non-economic factors• Provision of market value (USD Billion) data for each segment and sub-segment• Indicates the region and segment that is expected to witness the fastest growth as well as to dominate the market• Analysis by geography highlighting the consumption of the product/service in the region as well as indicating the factors that are affecting the market within each region• Competitive landscape which incorporates the market ranking of the major players, along with new service/product launches, partnerships, business expansions, and acquisitions in the past five years of companies profiled• Extensive company profiles comprising of company overview, company insights, product benchmarking, and SWOT analysis for the major market players• The current as well as the future market outlook of the industry with respect to recent developments which involve growth opportunities and drivers as well as challenges and restraints of both emerging as well as developed regions• Includes in-depth analysis of the market of various perspectives through Porter’s five forces analysis• Provides insight into the market through Value Chain• Market dynamics scenario, along with growth opportunities of the market in the years to come• 6-month post-sales analyst support

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