Healthcare EDI Market

The healthcare EDI market is projected to reach USD  7.1 billion by 2029 from USD  4.5 billion in 2024, at a CAGR of 9.7% from 2024  to 2029. The major factors driving the growth of the healthcare EDI market include supportive regulations for transaction processes, the growing necessity to reduce healthcare costs, and API integration accelerating claims management. Regulatory compliance with HIPAA standards, the inception of the Affordable Care Act, and US Centers for Medicare & Medicaid Services (CMS)’s EDI mandates (Enrollment, Transaction authorization, etc) have significantly enhanced data privacy, security, and interoperability mandates for healthcare EDI transactions. Moreover, API integrations have enabled automated workflows for claims management processes, which augments the market growth.

The major players in the healthcare EDI market with a significant global presence are McKESSON CORPORATION (US), UnitedHealth Group Incorporated (US), Cognizant (US), IBM (US), Veradigm LLC (US), Experian Information Solutions, Inc. (US), athenahealth (US), The SSI Group, LLC (US), NTT DATA Group Corporation (Japan), Comarch SA. (Poland), Axway (US), Availity, LLC. (US), Quadax, Inc. (US), Waystar. (US), PLEXIS Healthcare Systems (US), Boomi (US), True Commerce, Inc. (US), Inovalon. (US), 123 EDI (US), Cirius Group, Inc. (US), Epicor Software Corporation (US), OSP Labs (US), Nalashaa. (US), WNS (US), PilotFish, Inc. (US), and Cleo (US). The market players have adopted strategies such as acquisitions, collaborations, partnerships, mergers, product/service launches & enhancements, and approvals to strengthen their position in the healthcare EDI market. The product and technology innovations have helped the market players expand globally by providing advanced claims management and supply management solutions.

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McKESSON CORPORATION

McKesson CORPORATION provides software and services used in pharmacy services, specialty practices, biopharma, pharmaceutical distribution, and medical supplies and equipment. The company has a strong foothold in the US, from where it generated more than 90% share of its revenue. The company provides claims management and supply management software and services. It adopted acquisitions and product approvals as critical strategies to increase its revenue. The company’s supply management offerings provide data exchange tools that streamline pharmacy operations by managing product data for pricing updates, purchase orders, invoicing, and customization for specific customer needs. Their claims management solution offers claims processing and supports various plan types like Medicaid, Medicare, FIDA, dual-eligibility services, and automated electronic payments.

UnitedHealth Group Incorporated

UnitedHealth Group is a healthcare company that offers healthcare products and insurance services. The company caters to a broad range of healthcare providers, such as hospitals, doctors, pharmacies, health plan organizations, and life science companies. Through Optum, the company provides integrated claims management software designed explicitly for eligibility and referrals, prior authorization, claims status, and reconsideration. The company has created a significant footprint in the healthcare services industry through investments in digital health innovations and collaborations with healthcare providers.

Cognizant

Cognizant has a strong geographical footprint across North America and Europe, from where it generated more than 90% share of its revenue. Cognizant offers claims management software that simplifies the process of handling EDI for healthcare payers. With EDI consolidation functionality, it consolidates all interactions into one efficient system instead of managing multiple connections.

Related Reports:

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

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