Healthcare EDI Market by Component (EDI Software, EDI Services), Transactions (Claim Status, Eligibility Verification), Mode of Delivery (Web-based EDI, Mobile EDI, EDI Van) & by End-users (Healthcare Payers, Providers) - Global Forecast to 2018

Electronic Data Interchange (EDI) has helped evolve the healthcare market for claims management and supply chain management to depend from paper based to electronic based mode of transactions. The benefits associated with the use of EDI such as cost reductions and reduced time of transactions has helped improve the acceptance of this technology in the healthcare market.

In this report the global healthcare EDI market is broadly segmented by components, type of transactions, end-users, and mode of delivery. The market based on components are further divided into EDI software and EDI services, whereas, the type of transactions are divided into claims status, eligibility verification, payment remittance, referral certification authorization, enrolment/disenrollment transactions, and premium payments. On the basis of end-users the market is sub-segmented into healthcare payers, healthcare providers, and medical equipment/accessories suppliers. Based on mode of deliveries, the market is divided into web-based EDI, point-to-point EDI, mobile EDI, EDI VAN, and EDI via AS2.

Over the past few years, the healthcare EDI market has shown a substantial growth. The market is expected to grow at a CAGR of 13.7% from 2013 to 2018 to reach $1,681.1 million by 2018. EDI has been increasingly embraced by the healthcare industry, and is experiencing a growth due to various advantages associated with its use like reduction of the administration costs, reduced errors and time for transfer of claims, and initiatives by various governments. The passing of the Obamacare Act in 2010, in the United States has mandated the use of enrolment/disenrollment transactions between the payers and providers in the U.S., with the North American market contributing the maximum share of the global healthcare EDI market. The European market also occupies a significant share of the global healthcare EDI market, with the Asian regions showing the maximum growth due to various factors like large population, growing burden of diseases, and government initiatives for the support of healthcare IT in these regions.


The prominent players in the global healthcare EDI market include Emdeon Inc. (U.S.), Allscripts (U.S.), Mckesson (U.S.), Optum Health (U.S.), GE Healthcare (U.K.), Siemens Healthcare (Germany), SSI Group (U.S.), ZirMed (U.S.), Passport Health communications (U.S.), and Capario (U.S.).
Reasons to Buy the Report:
The report will enrich both established firms as well as new entrants/smaller firms to gauge the pulse of the market, which in turn will help firms, garner greater market shares. Firms purchasing the report could use any one or a combination of the below mentioned five strategies (market penetration, product development/innovation, market development, market diversification, and competitive assessment) for increasing their market shares.

The report provides insights on the following pointers:
‧ Market Penetration: Comprehensive information on the product portfolios offered by the top players in the healthcare EDI market. The report analyzes the healthcare EDI market by components, type of transactions, end-users, and mode of delivery.
‧ Product Development/Innovation: Detailed insights on the upcoming trends, research and development activities, and new product launches in the healthcare EDI market.
‧ Market Development: Comprehensive information about the lucrative emerging markets by product, functionality, and geography.
‧ Market Diversification: Exhaustive information about new products, growing geographies, recent developments, and investments in the healthcare EDI market.
‧ Competitive Assessment: In-depth assessment of market shares, growth strategies, products, distribution networks, manufacturing capabilities, and SWOT analysis of the leading players in the healthcare EDI market.

TABLE OF CONTENTS

1 INTRODUCTION 17
1.1 OBJECTIVES OF THE STUDY 17
1.2 REPORT DESCRIPTION 17
1.3 MARKETS COVERED 19
1.4 STAKEHOLDERS 20
1.5 RESEARCH METHODOLOGY 21
1.5.1 MARKET SIZE ESTIMATION 23
1.5.2 MARKET CRACKDOWN AND DATA TRIANGULATION 24
1.5.3 KEY DATA FROM SECONDARY RESOURCES 26
1.5.4 KEY DATA POINTS FROM PRIMARY RESOURCES 26
1.5.5 ASSUMPTIONS 28
2 EXECUTIVE SUMMARY 29
3 MARKET DYNAMICS 33
3.1 INTRODUCTION 34
3.2 MARKET SEGMENTATION 35
3.3 MARKET DYNAMICS 36
3.3.1 KEY MARKET DRIVERS 37
3.3.1.1 The Healthcare Insurance Portability and Accountability Act, 1996, to propel the adoption of EDI in healthcare 37
3.3.1.2 Patient Protection and Affordability Care Act 37
3.3.1.3 Initiatives by different governments for encouragement of healthcare IT 38
3.3.2 KEY MARKET RESTRAINTS 38
3.3.2.1 Data security—a major concern for patients and EDI users 38
3.3.2.2 High cost of EDI software 39
3.3.2.3 EDI management—a major challenge inhibiting the adoption of EDI 40
3.3.2.4 Restricted investments in Healthcare IT 40
3.3.2.5 Limited reimbursements to hinder the growth in the BRIC nations 41
3.3.3 KEY MARKET OPPORTUNITIES 41
3.3.3.1 Increase in the outsourcing of EDI services 41
3.3.3.2 Conversion from ICD-9 to ICD-10 42
3.3.4 KEY MARKET TRENDS 42
3.3.4.1 Increasing use of EDI in healthcare manufacturing/distribution industry 42
3.3.4.2 Gradual acceptance of mobile EDI 43
3.4 EVOLUTION OF EDI AND ITS FUTURE 43
3.5 BENEFITS OF EDI IN HEALTHCARE INDUSTRY 46
3.5.1 QUICKER PAYMENT OF CLAIMS AND DETECTION OF ERRORS 46
3.5.2 REDUCED ADMINISTRATIVE AND HANDLING COSTS 46
3.5.3 ACCESS TO ALL ELECTRONIC HIPAA-COMPLIANT TRANSACTIONS 47
3.5.4 OTHER BENEFITS TO MEDICARE “A” PROVIDERS 47
3.6 EDI STANDARDS FOR HEALTHCARE INDUSTRY 48
3.7 MARKET SHARE ANALYSIS 49
4 HEALTHCARE EDI MARKET, BY PRODUCT 52
4.1 INTRODUCTION 53
4.2 HEALTHCARE EDI MARKET, BY COMPONENT 54
4.2.1 SOFTWARE 55
4.2.2 SERVICES 57
4.3 HEALTHCARE EDI MARKET, BY TYPE OF TRANSACTION 59
4.3.1 CLAIM STATUS 60
4.3.2 ELIGIBILITY VERIFICATION 62
4.3.3 PAYMENT REMITTANCE 64
4.3.4 REFERRAL CERTIFICATION AUTHORIZATION 66
4.3.5 ENROLLMENT/DISENROLLMENT TRANSACTIONS 67
4.3.6 PREMIUM PAYMENTS 69
4.4 HEALTHCARE EDI MARKET, BY MODE OF DELIVERY 71
4.4.1 WEB-BASED EDI/EDI CLOUD 72
4.4.2 EDI VIA AS2 74
4.4.3 POINT-TO-POINT EDI 75
4.4.4 EDI VAN 77
4.4.5 MOBILE EDI 78
5 HEALTHCARE EDI MARKET, BY END USER 80
5.1 INTRODUCTION 81
5.2 HEALTHCARE PROVIDERS 83
5.2.1 HEALTHCARE PAYERS 84
5.2.2 GOVERNMENT/PUBLIC PAYERS 86
5.2.3 PRIVATE PAYERS 88
5.3 MEDICAL EQUIPMENT AND ACCESSORIES SUPPLIERS/PHARMACIES 90
6 GEOGRAPHIC ANALYSIS 92
6.1 INTRODUCTION 93
6.2 NORTH AMERICA 95
6.2.1 U.S. 99
6.2.2 CANADA 105
6.3 EUROPE 111
6.4 ASIA 116
6.5 REST OF THE WORLD 121
7 COMPETITIVE LANDSCAPE 126
7.1 INTRODUCTION 126
7.1.1 NEW PRODUCT LAUNCHES 128
7.1.2 MERGERS AND ACQUISITIONS 130
7.1.3 AGREEMENTS, ALLIANCES, COLLABORATIONS, JOINT VENTURES, AND PARTNERSHIPS 132
7.1.4 OTHER DEVELOPMENTS 133
8 COMPANY PROFILES 135
(Overview, Financials, Products & Services, Strategy, & Developments)*
8.1 ALLSCRIPTS HEALTHCARE SOLUTIONS INC. 135
8.2 CAPARIO INC. 142
8.3 EMDEON INC. 145
8.4 GE HEALTHCARE
(A DIVISION OF GENERAL ELECTRIC COMPANY) 159
8.5 MCKESSON CORPORATION 167
8.6 OPTUM INC. 175
8.7 PASSPORT HEALTH COMMUNICATIONS INC. 180
8.8 SIEMENS HEALTHCARE (SUBSIDIARY OF SIEMENS AG.) 186
8.9 SSI GROUP INC. 193
8.10 ZIRMED INC. 197

*Details on Financials, Product & Services, Strategy, & Developments might not be captured in case of unlisted companies.
APPENDIX 201