U.S. Healthcare Denial Management Market - Industry Outlook & Forecast 2022-2027

U.S. Healthcare Denial Management Market - Industry Outlook & Forecast 2022-2027

In-depth Analysis and Data-driven Insights on the Impact of COVID-19 Included in this U.S. Healthcare Denial Management Market Report

The U.S. healthcare denial management market size was valued at USD 3.57 billion in 2021 and is expected to reach USD 5.94 billion by 2027, growing at a CAGR of 8.86% during the forecast period.

Over the past several years, the claim denial rates in hospitals moved upwards but reached new highs with the public health emergency of COVID-19. During this time, the medical claim denials have risen 11% nationwide in the US, with the most denial rates accounting for 13.1% in the Pacific Coast and 12.9% in the Northeast. In the US, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was developed for providing healthcare resources that were needed to fight COVID-19. CARES Act included medical billing provisions, leading to an uptick in claim denials. This will further drive Healthcare Claims Management in the country.

The following factors are likely to contribute to the growth of the healthcare denial management market –

• A growing number of medical claim denials
• Increasing payer complexities for healthcare claims
• Shift Towards Value-based Reimbursement
• Errors in Medical Billing and Healthcare Claims
• Need for standardization & trained professionals

KEY HIGHLIGHTS

• The rise in automation and AI-based denial management is a major trend in the market by helping in better managing claim denials.
• The growing need to reduce and manage claim denial as well as decrease the revenue impact to healthcare systems due to the loss in denials is contributing to the increase in adoption of denial management software
• The shift toward value-based solutions in the market is encouraging healthcare companies to shift towards automated denial management solutions.
• To maximize reimbursement and recuperate the lost healthcare revenue, providers have started enhancing claim denial management with various strategies which will increase the adoption of the healthcare denial management market in the US.

U.S. HEALTHCARE DENIAL MANAGEMENT MARKET SEGMENTS

U.S. healthcare denial management market is segmented on the basis of-

• Component
• Type
• Delivery Mode
• End-user

U.S. HEALTHCARE DENIAL MANAGEMENT MARKET SEGMENTATION

• Integrated held the major share by type. This can be attributed to the fact that EHR integrated with denial management has many benefits. This includes easy access to health information, improved diagnostics, and treatment, data privacy and security, minimizing medical errors, enhancing efficiency, and reducing costs.
• Cloud-based solutions give insurers the flexibility to service policyholders and efficiently manage heavy workloads. Increasing adoption of the cloud-based model across several regions is enabling a mechanism to distribute the system and data across different locations. Also, cloud-based solutions mitigate the risk of data loss or inaccessibility due to a disaster. All these factors will drive the growth of cloud-based solutions in denials management programs.

Market Segmentation by Component

• Soft Denial
• Hard Denial

Market Segmentation by Type

• Integrated
• Standalone

Market Segmentation by Delivery Mode

• Web & Cloud-Based
• On-Premises

Market Segmentation by End-User

• Healthcare Providers

Hospitals

Physician’s Office

Others

• Healthcare Payers

VENDOR LANDSCAPE

• The key players in the healthcare denial management market are UnitedHealth Group, McKesson Corporation, Change Healthcare, eClinicalWorks, Experian, Allscripts Healthcare Solutions, etc.
• There has been a rise in acquisitions of many third-party vendors by large companies. For instance, ARMC, specializing in denials management, was recently acquired by Longshore Capital Partners and Revco Solutions to expand geographic coverage and add an extra service for its clients.

Key Vendors

• UnitedHealth Group
• McKesson
• Change Healthcare
• eClinicalWorks
• Experian
• Allscripts Healthcare Solutions

Other Prominent Vendors

• 24/7 Medical Billing Services
• 3D Solutions
• 3Gen Consulting
• 4D Global
• Accenture
• Access Healthcare
• Acrologic Business Solutions
• AdvancedMD
• AdvantEdge Healthcare Solutions
• Advantum Health
• Aergo Solutions
• Aetna
• Alaska Billing Services
• AllianceMed
• BillingParadise
• Bizmatics
• CareCloud
• ChartLogic
• Cigna
• Cognizant
• Coronis Health
• Craneware
• Credit Management Company
• CureMD Healthcare
• Data Marshall
• DrChrono
• EHealthSource
• Greenway Health
• Golden West Medical Billing
• InSync Healthcare Solutions
• IntelliRCM
• Intersect Healthcare
• iSalus
• Kareo
• McBee Associates
• MedEx Medical Billing
• Medforce Technologies
• Medical Billers and Coders
• Medmecs Billing Services
• MGSI
• MRO
• NXGN Management
• OSP
• Persistent Systems
• PMMC
• Procure Billing Solutions
• Promantra
• Quadax
• QWay Healthcare
• R1 RCM
• Resolutions Billing & Consulting
• Revele
• RevenueXL
• Right Medical Billing
• Savista
• Superior Medical Management
• TriMed Technologies
• Vee Technologies
• Vitruvian MedPro
• Waystar

KEY QUESTIONS ANSWERED:

1. What is the size of the U.S. healthcare denial management market?

2. What are the current trends in the U.S. healthcare denial management market?

3. Who are the key players in the healthcare denial management market in the U.S.?

4. Who are the end-users in the U.S. healthcare denial management industry?

5. Which segment has the highest share in the U.S. healthcare denial management market?