North America Healthcare EDI Market Size By Component (Services, Solutions), By Delivery Mode (Web And Cloud-Based EDI, EDI Value Added Network (VAN)), By End-Use (Healthcare Payers, Healthcare Providers), By Geographic Scope And Forecast

North America Healthcare EDI Market Size And Forecast

North America Healthcare EDI Market size was valued at USD 2344.8 Million in 2024 and is projected to reach USD 4025.57 Million by 2031, growing at a CAGR of 7.71% from 2024 to 2031.

Rising healthcare expenses, along with technological advances in electronic data exchange (EDI), are likely to drive market expansion. Furthermore, an increase in the number of end-users, combined with increased EDI adoption, is expected to support market growth during the forecast period. Healthcare EDI aids in the automation of business activities such as claim filing and payment, insurance eligibility verification, and data reporting. According to the Maryland Healthcare Commission, claim filings are the most prevalent electronic transaction in health care. Thus, EDI finds notable applications in this sector.

North America Healthcare EDI Market Definition

Electronic Data Interchange (EDI) is a software medium that allows data to be exchanged between various healthcare providers and payers via computer systems. Using the EDI service, the organizer may process and track claims throughout the billing cycle. Healthcare EDI is used to handle the patient’s medical history, pharmaceutical data, and emergency services records, all of which are regarded as vital data in the healthcare industry.

Claim management, healthcare supply chain, and other transactions are the most common types of transactions in healthcare EDI. Claim management is the process of organizing, billing, submitting, amending, and processing healthcare claims related to patient diagnosis, medicines, and treatment. Software, hardware, and services are among the numerous components, as are various delivery modalities such as mobile, VAN, online & cloud-based, and point-to-point. Healthcare providers, payers, pharmacies, and other end users rely on these.

North America Healthcare EDI Market Overview

A rising patient population due to the increasing frequency of chronic diseases, an increased need to decrease healthcare expenses, and government support for healthcare EDI are some of the key reasons driving market expansion. According to the World Health Organisation (WHO), chronic disease is the major cause of mortality in the region. The number of patients grows in tandem with the incidence of these chronic illnesses. Similarly, the increasing number of fatalities necessitates the usage of healthcare EDI systems for various reimbursement claims.

The expanding number of EDI providers will propel the Healthcare Electronic Data Interchange industry ahead. Such EDI providers are effectively addressing the industry’s issues. EDI providers, for example, manage time-consuming tasks such as communicating with trade partners and clients, troubleshooting, and resolving software difficulties. They are in charge of dealing with EDI requirements set by government agencies as well as assuring compliance with current laws and regulations. Paper papers, unprotected SMS and emails, USD drives, fax, PDF files, and other paper-based interactions have been phased out with the emergence of Healthcare Electronic Data Interchange platforms.

The healthcare Electronic Data Interchange industry, on the other hand, has adopted a standard structured format for sensitive data; these qualities have given considerable potential prospects for the North America Healthcare EDI Market. The high prices of electronic data exchange systems limit market expansion. The availability of low-cost cloud solutions is likely to stimulate expansion in the healthcare electronic data interchange (EDI) sector in the United States. Technological improvements may make the electronic data transfer more challenging.

North America Healthcare EDI MarketSegmentation Analysis

The North America Healthcare EDI Market is Segmented on the basis of Component, Delivery Mode, End-Use, and Geography.

North America Healthcare EDI Market, By Component

• Services
• Solutions

Based on Component, the market is segmented into Services and Solutions. The services segment is likely to dominate the market due to the increasing prevalence of healthcare organizations outsourcing electronic data interchange services and the increasing need for scalability and integrity of EDI solutions. Because it reduces administrative costs, accelerates information processing, ensures data accuracy, eliminates certain business transactions, streamlines business procedures, and strengthens customer or vendor relations, the solutions segment is expected to grow favorably over the forecast period.

North America Healthcare EDI Market, By Delivery Mode

• Web and Cloud-based EDI
• EDI Value Added Network (VAN)
• Direct (Point-to-Point) EDI
• Mobile EDI

Based on Delivery Mode, the market is segmented into Web and Cloud-based EDI, EDI Value Added Network (VAN), Direct (Point-to-Point) EDI, and Mobile EDI. Due to the increased demand from small and medium-sized healthcare providers for cheaper solutions with enhanced flexibility and scalability, the web and cloud-based EDI sector is expected to lead the North America Healthcare EDI Market. Over the forecast period, the mobile EDI segment is expected to grow at a faster rate. This is attributable to technical improvements in the healthcare business, as well as the growing acceptability of mobile solutions among healthcare practitioners.

North America Healthcare EDI Market, By End-Use

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

Based on End-Use, the market is segmented into Healthcare Payers, Healthcare Providers, Pharmaceutical & Medical Device Industries, and Others. During the forecast period, the payers’ segment is expected to have a comparatively higher market share. This is due to an increase in demand from insurance companies and healthcare payer organizations for the review of insurance claims prior to payment settlement, the prevention and detection of fraudulent claims, and the assessment of disease risk. The providers’ category, on the other hand, is predicted to grow at a faster rate throughout the projection period. This is due to the increasing use of EDI by physicians and clinicians, hospitals, clinics, and medical assessment centers for operational intelligence, performance management, and financial management.

North America Healthcare EDI Market, By Geography

• U.S.
• Canada
• Mexico

Based on Regional Analysis, the North America Healthcare EDI Market is classified into U.S., Canada, and Mexico. The U.S. is dominating the market due to the rising healthcare costs and technological advances in electronic data interchange (EDI) are expected to drive market growth in the U.S. Furthermore, increased EDI adoption and an increase in the number of end-users are expected to support market growth during the forecast period. Healthcare EDI helps to automate business activities such as claim filing and payment, insurance eligibility verification, and data reporting. Claim submissions are the most prevalent electronic transaction in health care, according to the Maryland Healthcare Commission. As a result, EDI has significant applicability in this area.

Key Players

The “North America Healthcare EDI Market” study report will provide valuable insight with an emphasis on the North America market including some of the major players such as MCKESSON CORPORATION, Optum, Inc., athenahealth, Inc., PLEXIS Healthcare Systems Inc., Allscripts Healthcare, LLC, General Electric, TrueCommerce B2BGateway, NXGN Management, LLC, Experian Information Solutions, Inc., Cerner Corporation, SYNNEX Corporation, Cognizant, Boomi, LP, Waystar.

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.

Key Developments

• In 2021, With the acquisition of Vanderbilt Health Rx Solutions, McKesson Corporation extended its integrated pharmacy services for specialty clinics business. This approach will help customize pharmaceutical services to the requirements of hospitals and health systems. All business services operations will be streamlined as a result of the partnership. This will help the company’s service quality improve. A better process system and a speedier solution will help the market.
• In 2020, Athenahealth, Inc. announced the release of its gamified solution for the healthcare market. The purpose of this solution was to increase the revenue cycle performance of the organization. Due to uncertainties, the company’s performance was mediocre; hence, the product was developed to boost productivity and track income.
• In 2019, Epicor Software Corporation acquired 1 EDI Source, Inc., a provider of business visibility software and electronic data interchange (EDI) solutions. This expanded Epicor’s Business Services offering and helped the firm achieve its aim of becoming the cloud provider of choice in target markets.

Ace Matrix Analysis

The Ace Matrix provided in the report would help to understand how the major key players involved in this industry are performing as we provide a ranking for these companies based on various factors such as service features & innovations, scalability, innovation of services, industry coverage, industry reach, and growth roadmap. Based on these factors, we rank the companies into four categories as Active, Cutting Edge, Emerging, and Innovators.

Market Attractiveness

The image of market attractiveness provided would further help to get information about the region that is majorly leading in the North America Healthcare EDI Market. We cover the major impacting factors that are responsible for driving the industry growth in the given region.

Porter’s Five Forces

The image provided would further help to get information about Porter’s five forces framework providing a blueprint for understanding the behavior of competitors and a player’s strategic positioning in the respective industry. Porter’s five forces model can be used to assess the competitive landscape in North America Healthcare EDI Market gauge the attractiveness of a certain sector, and assess investment possibilities.

Report Scope

Research Methodology of Market Research

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