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North American Claim Management System Market

  • Report Code: PA 1001
  • Publish Date: Upcoming
  
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Claim processing is a complex process, involving the payer and healthcare provider, wherein the process revolves around the fulfillment of the obligation by an insurer to receive, investigate and act on a claim filed by an insured person. It involves multiple administrative and customer service layers that includes review, investigation, adjustment (if necessary), remittance or denial of the claim.

North America accounts for the largest share of the payer claim management market globally in 2013. The market value was pegged at $1811 million in 2012 and is expected to grow at a CAGR of 6.2% from 2013 to 2018.

American Medical Association 2010 National Health Insurer Report Card estimated that one in five medical claims are processed inaccurately. These processing errors cost the healthcare industry an estimated $15.5 billion every year. Claims management software assists in reducing the number of mistakes in claims, which is one of the major driving factors for the claims processing software.

Claims processing is the heart of the entire payer industry. Claims process generates a large amount of data which is complex in nature, the claims processing software helps in managing this data in an effective and efficient way. The software also helps in gap analysis, and authenticates data.

This market is segmented and forecasted on the basis of two different types namely Integrated Payer Claim Management and Standalone Payer Claim Management. Standalone Payer Claim Management accounts for the largest share of NA Payer Claim Management market and is expected to grow at a CAGR of 7.2% from 2013 to 2018. On the basis of Components and Deployments the market is segmented into Hardware, Software and Services, while the Deployments are on-premise, Cloud-based, and Web-based. The market is further segmented and forecasted on the basis of major countries, such as U.S., Canada, and Mexico. The market is also segmented and analyzed further on the basis of the end-users.

The report provides an extensive competitive landscaping of companies operating in this market. The key players of the market covered in the report are Aspect Software, Avaya Inc., Cerner Corporation, Infor, Oracle Corporation. This report also includes the market share, value chain analysis, and market metrics such as drivers, restraints and upcoming opportunities in the market. 
1 Introduction
1.1 Objective of the study
1.2 Market Definition and Scope of the study
1.3 Markets Covered
1.4 Stakeholders
2 Research Methodology
2.1 INTEGRATED ECOSYSTEM OF PAYER CLAIM MANAGEMENT
2.2 ARRIVING AT PAYER CLAIM MANAGEMENT MARKET SIZE
2.3 TOP DOWN APPROACH
2.4 BOTTOM-UP APPROACH
2.5 DEMAND (CONSUMPTION) SIDE ANALYSIS
2.6 Macro indicators
2.7 Assumptions
3 EXECUTIVE SUMMARY
4 MARKET OVERVIEW
4.1 INTRODUCTION
4.2 PARENT MARKET COMPARISON
4.3 DRIVERS AND INHIBITORS FOR PAYER CLAIM MANAGEMENT MARKET
4.4 DEMAND SIDE ANALYSIS
4.5 VENDOR SIDE ANALYSIS
5 Payer Claim Management-North America, By Deployments
5.1 Split By Geography
5.1 Payer Claim Management-U.S. by Deployments
5.1 Payer Claim Management-Canada by Deployments
5.1 Payer Claim Management-Mexico by Deployments
5.2 Payer Claim Management-North America-Web-based Healthcare IT
5.2.1 Payer Claim Management-North America-Web-based Healthcare IT, By Geographies
5.2.1.1 Payer Claim Management-U.S.-Web-based Healthcare IT
5.2.1.2 Payer Claim Management-Canada-Web-based Healthcare IT
5.2.1.3 Payer Claim Management-Mexico-Web-based Healthcare IT
5.2.2 Payer Claim Management-North America-Web-based Healthcare IT, By Products
5.2.2.1 Standalone Payer Claim Management-North America-Web-based Healthcare IT
5.2.2.2 Integrated Payer Claim Management-North America-Web-based Healthcare IT
5.3 Payer Claim Management-North America-On-premise Healthcare IT
5.3.1 Payer Claim Management-North America-On-premise Healthcare IT, By Geographies
5.3.1.1 Payer Claim Management-U.S.-On-premise Healthcare IT
5.3.1.2 Payer Claim Management-Canada-On-premise Healthcare IT
5.3.1.3 Payer Claim Management-Mexico-On-premise Healthcare IT
5.3.2 Payer Claim Management-North America-On-premise Healthcare IT, By Products
5.3.2.1 Standalone Payer Claim Management-North America-On-premise Healthcare IT
5.3.2.2 Integrated Payer Claim Management-North America-On-premise Healthcare IT
5.4 Payer Claim Management-North America-Cloud-based
5.4.1 Payer Claim Management-North America-Cloud-based, By Geographies
5.4.1.1 Payer Claim Management-U.S.-Cloud-based
5.4.1.2 Payer Claim Management-Canada-Cloud-based
5.4.1.3 Payer Claim Management-Mexico-Cloud-based
5.4.2 Payer Claim Management-North America-Cloud-based, By Products
5.4.2.1 Standalone Payer Claim Management-North America-Cloud-based
5.4.2.2 Integrated Payer Claim Management-North America-Cloud-based
6 Payer Claim Management-North America, By Components
6.1 Split By Geography
6.2 Payer Claim Management-U.S. by Components
6.1 Payer Claim Management-Canada by Components
6.1 Payer Claim Management-Mexico by Components
6.2 Payer Claim Management-North America-Services (Healthcare IT)
6.2.1 Payer Claim Management-North America-Services (Healthcare IT), By Geographies
6.2.1.1 Payer Claim Management-U.S.-Services (Healthcare IT)
6.2.1.2 Payer Claim Management-Canada-Services (Healthcare IT)
6.2.1.3 Payer Claim Management-Mexico-Services (Healthcare IT)
6.2.2 Payer Claim Management-North America-Services (Healthcare IT), By Products
6.2.2.1 Standalone Payer Claim Management-North America-Services (Healthcare IT)
6.2.2.2 Integrated Payer Claim Management-North America-Services (Healthcare IT)
6.3 Payer Claim Management-North America-Software (Healthcare IT)
6.3.1 Payer Claim Management-North America-Software (Healthcare IT), By Geographies
6.3.1.1 Payer Claim Management-U.S.-Software (Healthcare IT)
6.3.1.2 Payer Claim Management-Canada-Software (Healthcare IT)
6.3.1.3 Payer Claim Management-Mexico-Software (Healthcare IT)
6.3.2 Payer Claim Management-North America-Software (Healthcare IT), By Products
6.3.2.1 Standalone Payer Claim Management-North America-Software (Healthcare IT)
6.3.2.2 Integrated Payer Claim Management-North America-Software (Healthcare IT)
6.4 Payer Claim Management-North America-Hardware.
6.4.1 Payer Claim Management-North America-Hardware., By Geographies
6.4.1.1 Payer Claim Management-U.S.-Hardware.
6.4.1.2 Payer Claim Management-Canada-Hardware.
6.4.1.3 Payer Claim Management-Mexico-Hardware.
6.4.2 Payer Claim Management-North America-Hardware., By Products
6.4.2.1 Standalone Payer Claim Management-North America-Hardware.
6.4.2.2 Integrated Payer Claim Management-North America-Hardware.
7 Payer Claim Management-North America, By Endusers
7.1 Split By Geography
7.3 Payer Claim Management-U.S. by Endusers
7.1 Payer Claim Management-Canada by Endusers
7.1 Payer Claim Management-Mexico by Endusers
7.2 Payer Claim Management-North America-Hospitals
7.2.1 Payer Claim Management-North America-Hospitals, By Geographies
7.2.1.1 Payer Claim Management-U.S.-Hospitals
7.2.1.2 Payer Claim Management-Canada-Hospitals
7.2.1.3 Payer Claim Management-Mexico-Hospitals
7.2.2 Payer Claim Management-North America-Hospitals, By Products
7.2.2.1 Standalone Payer Claim Management-North America-Hospitals
7.2.2.2 Integrated Payer Claim Management-North America-Hospitals
7.3 Payer Claim Management-North America-Office based Physicians
7.3.1 Payer Claim Management-North America-Office based Physicians, By Geographies
7.3.1.1 Payer Claim Management-U.S.-Office based Physicians
7.3.1.2 Payer Claim Management-Canada-Office based Physicians
7.3.1.3 Payer Claim Management-Mexico-Office based Physicians
7.3.2 Payer Claim Management-North America-Office based Physicians, By Products
7.3.2.1 Standalone Payer Claim Management-North America-Office based Physicians
7.3.2.2 Integrated Payer Claim Management-North America-Office based Physicians
7.4 Payer Claim Management-North America-Nurses
7.4.1 Payer Claim Management-North America-Nurses, By Geographies
7.4.1.1 Payer Claim Management-U.S.-Nurses
7.4.1.2 Payer Claim Management-Canada-Nurses
7.4.1.3 Payer Claim Management-Mexico-Nurses
7.4.2 Payer Claim Management-North America-Nurses, By Products
7.4.2.1 Standalone Payer Claim Management-North America-Nurses
7.4.2.2 Integrated Payer Claim Management-North America-Nurses
7.5 Payer Claim Management-North America-Emergency Healthcare Service providers
7.5.1 Payer Claim Management-North America-Emergency Healthcare Service providers, By Geographies
7.5.1.1 Payer Claim Management-U.S.-Emergency Healthcare Service providers
7.5.1.2 Payer Claim Management-Canada-Emergency Healthcare Service providers
7.5.1.3 Payer Claim Management-Mexico-Emergency Healthcare Service providers
7.5.2 Payer Claim Management-North America-Emergency Healthcare Service providers, By Products
7.5.2.1 Standalone Payer Claim Management-North America-Emergency Healthcare Service providers
7.5.2.2 Integrated Payer Claim Management-North America-Emergency Healthcare Service providers
7.6 Payer Claim Management-North America-Other Healthcare Providers
7.6.1 Payer Claim Management-North America-Other Healthcare Providers, By Geographies
7.6.1.1 Payer Claim Management-U.S.-Other Healthcare Providers
7.6.1.2 Payer Claim Management-Canada-Other Healthcare Providers
7.6.1.3 Payer Claim Management-Mexico-Other Healthcare Providers
7.6.2 Payer Claim Management-North America-Other Healthcare Providers, By Endusers
7.6.2.1 Payer Claim Management-North America-Emergency Healthcare Service providers
7.6.2.2 Payer Claim Management-North America-Nurses
7.6.3 Payer Claim Management-North America-Other Healthcare Providers, By Products
7.6.3.1 Standalone Payer Claim Management-North America-Other Healthcare Providers
7.6.3.2 Integrated Payer Claim Management-North America-Other Healthcare Providers
8 Payer Claim Management-North America, By Products
8.1 Split By Geography
8.4 Payer Claim Management-U.S. by Products
8.1 Payer Claim Management-Canada by Products
8.1 Payer Claim Management-Mexico by Products
8.2 Standalone Payer Claim Management-North America
8.2.1 Standalone Payer Claim Management-North America, By Deployments
8.2.1.1 Standalone Payer Claim Management-North America-Web-based Healthcare IT
8.2.1.2 Standalone Payer Claim Management-North America-On-premise Healthcare IT
8.2.1.3 Standalone Payer Claim Management-North America-Cloud-based
8.2.2 Standalone Payer Claim Management-North America, By Components
8.2.2.1 Standalone Payer Claim Management-North America-Services (Healthcare IT)
8.2.2.2 Standalone Payer Claim Management-North America-Software (Healthcare IT)
8.2.2.3 Standalone Payer Claim Management-North America-Hardware.
8.2.3 Standalone Payer Claim Management-North America, By Endusers
8.2.3.1 Standalone Payer Claim Management-North America-Hospitals
8.2.3.2 Standalone Payer Claim Management-North America-Office based Physicians
8.2.3.3 Standalone Payer Claim Management-North America-Nurses
8.2.3.4 Standalone Payer Claim Management-North America-Emergency Healthcare Service providers
8.2.3.5 Standalone Payer Claim Management-North America-Other Healthcare Providers
8.2.4 Standalone Payer Claim Management-North America, By Geographies
8.2.4.1 Standalone Payer Claim Management-U.S.
8.2.4.2 Standalone Payer Claim Management-Canada
8.2.4.3 Standalone Payer Claim Management-Mexico
8.3 Integrated Payer Claim Management-North America
8.3.1 Integrated Payer Claim Management-North America, By Deployments
8.3.1.1 Integrated Payer Claim Management-North America-Web-based Healthcare IT
8.3.1.2 Integrated Payer Claim Management-North America-On-premise Healthcare IT
8.3.1.3 Integrated Payer Claim Management-North America-Cloud-based
8.3.2 Integrated Payer Claim Management-North America, By Components
8.3.2.1 Integrated Payer Claim Management-North America-Services (Healthcare IT)
8.3.2.2 Integrated Payer Claim Management-North America-Software (Healthcare IT)
8.3.2.3 Integrated Payer Claim Management-North America-Hardware.
8.3.3 Integrated Payer Claim Management-North America, By Endusers
8.3.3.1 Integrated Payer Claim Management-North America-Hospitals
8.3.3.2 Integrated Payer Claim Management-North America-Office based Physicians
8.3.3.3 Integrated Payer Claim Management-North America-Nurses
8.3.3.4 Integrated Payer Claim Management-North America-Emergency Healthcare Service providers
8.3.3.5 Integrated Payer Claim Management-North America-Other Healthcare Providers
8.3.4 Integrated Payer Claim Management-North America, By Geographies
8.3.4.1 Integrated Payer Claim Management-U.S.
8.3.4.2 Integrated Payer Claim Management-Canada
8.3.4.3 Integrated Payer Claim Management-Mexico
9 Payer Claim Management-North America, By Geographies
9.1 Payer Claim Management-U.S.
9.1.1 Payer Claim Management-U.S., By Deployments
9.1.1.1 Payer Claim Management-U.S.-Web-based Healthcare IT
9.1.1.2 Payer Claim Management-U.S.-On-premise Healthcare IT
9.1.1.3 Payer Claim Management-U.S.-Cloud-based
9.1.2 Payer Claim Management-U.S., By Components
9.1.2.1 Payer Claim Management-U.S.-Services (Healthcare IT)
9.1.2.2 Payer Claim Management-U.S.-Software (Healthcare IT)
9.1.2.3 Payer Claim Management-U.S.-Hardware.
9.1.3 Payer Claim Management-U.S., By Endusers
9.1.3.1 Payer Claim Management-U.S.-Hospitals
9.1.3.2 Payer Claim Management-U.S.-Office based Physicians
9.1.3.3 Payer Claim Management-U.S.-Nurses
9.1.3.4 Payer Claim Management-U.S.-Emergency Healthcare Service providers
9.1.3.5 Payer Claim Management-U.S.-Other Healthcare Providers
9.1.4 Payer Claim Management-U.S., By Products
9.1.4.1 Standalone Payer Claim Management-U.S.
9.1.4.2 Integrated Payer Claim Management-U.S.
9.2 Payer Claim Management-Canada
9.2.1 Payer Claim Management-Canada, By Deployments
9.2.1.1 Payer Claim Management-Canada-Web-based Healthcare IT
9.2.1.2 Payer Claim Management-Canada-On-premise Healthcare IT
9.2.1.3 Payer Claim Management-Canada-Cloud-based
9.2.2 Payer Claim Management-Canada, By Components
9.2.2.1 Payer Claim Management-Canada-Services (Healthcare IT)
9.2.2.2 Payer Claim Management-Canada-Software (Healthcare IT)
9.2.2.3 Payer Claim Management-Canada-Hardware.
9.2.3 Payer Claim Management-Canada, By Endusers
9.2.3.1 Payer Claim Management-Canada-Hospitals
9.2.3.2 Payer Claim Management-Canada-Office based Physicians
9.2.3.3 Payer Claim Management-Canada-Nurses
9.2.3.4 Payer Claim Management-Canada-Emergency Healthcare Service providers
9.2.3.5 Payer Claim Management-Canada-Other Healthcare Providers
9.2.4 Payer Claim Management-Canada, By Products
9.2.4.1 Standalone Payer Claim Management-Canada
9.2.4.2 Integrated Payer Claim Management-Canada
9.3 Payer Claim Management-Mexico
9.3.1 Payer Claim Management-Mexico, By Deployments
9.3.1.1 Payer Claim Management-Mexico-Web-based Healthcare IT
9.3.1.2 Payer Claim Management-Mexico-On-premise Healthcare IT
9.3.1.3 Payer Claim Management-Mexico-Cloud-based
9.3.2 Payer Claim Management-Mexico, By Components
9.3.2.1 Payer Claim Management-Mexico-Services (Healthcare IT)
9.3.2.2 Payer Claim Management-Mexico-Software (Healthcare IT)
9.3.2.3 Payer Claim Management-Mexico-Hardware.
9.3.3 Payer Claim Management-Mexico, By Endusers
9.3.3.1 Payer Claim Management-Mexico-Hospitals
9.3.3.2 Payer Claim Management-Mexico-Office based Physicians
9.3.3.3 Payer Claim Management-Mexico-Nurses
9.3.3.4 Payer Claim Management-Mexico-Emergency Healthcare Service providers
9.3.3.5 Payer Claim Management-Mexico-Other Healthcare Providers
9.3.4 Payer Claim Management-Mexico, By Products
9.3.4.1 Standalone Payer Claim Management-Mexico
9.3.4.2 Integrated Payer Claim Management-Mexico
10 Payer Claim Management-North America, By Companies
10.1 Competitive landscape
10.2 Split By Geography
10.5 Payer Claim Management-U.S. by Companies
10.1 Payer Claim Management-Canada by Companies
10.1 Payer Claim Management-Mexico by Companies
10.3 Payer Claim Management-North America-Oracle Corporation
10.4 Payer Claim Management-North America-Cerner Corporation
10.5 Payer Claim Management-North America-Aspect Imaging.
10.6 Payer Claim Management-North America-Other Companies
10.7 Payer Claim Management-North America-Avaya Inc.
10.8 Payer Claim Management-North America-Infor
11 Macro Indicator
12 Global Sub Markets

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