Overview

Staking a claim: The aging population and healthcare reform will support industry revenue

The Medical Claims Processing Services market research report provides key industry analysis and industry statistics, measures market size, analyzes current and future industry trends and shows market share for the industry’s largest companies. IBISWorld publishes the largest collection of industry reports so you can see an industry’s supply chain, economic drivers and key buyers and markets.

REPORT SNAPSHOT

Industry Threats & Opportunities

  • Rising demand for medical claims processing services has attracted new entrants to the industry
  • The aging baby boomers boosted demand for medical claims processing services through 2016
  • Growth in the senior population will boost the number of doctors’ visits, spurring demand

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    Industry Analysis & Industry Trends

    The industry will experience steady growth over the next five years, as the growing senior population creates demand via Medicare. Furthermore, the number of insured people will rise in line with healthcare reform, as people with pre-existing conditions are able to receive insurance. The growing senior population will keep driving demand for the industry's services over the next five years, helping revenue blossom...

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    Industry Report - Industry SWOT Analysis Chapter

    The Medical Claims Processing Services industry is in a growth life cycle stage, illustrated by its growing contribution the overall economy. Its industry value added (IVA), which measures the industry's contribution to the economy, is forecast to grow at an annualized rate of 9.3% over the 10 years to 2021. Meanwhile, GDP is anticipated to grow at an annualized rate of 2.1% over the same period, much slower than the industry IVA.

    The move to outsourcing medical claims processing occurred in the early 2000s, so the service is widely accepted and few changes are being made to the process. However, providers are expanding their offerings to include services such as worker's compensation claims processing, welfare funds administration and consulting. Thi..

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    Additional Insights for the Medical Claims Processing Services Industry

    IBISWorld identifies 250 Key Success Factors for a business.The most important for the Medical Claims Processing Services Industry are

  • Ability to vary services to suit different needs
  • Automation - reduces costs, particularly those associated with labor
  • Access to highly skilled workforce
  • IBISWorld analysts also discuss how external factors such as Number of physician visits and Number of people with private health insurance in the Medical Claims Processing Services industry impact industry performance..

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    Look under the hood?

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    Industry Products

    What is the Medical Claims Processing Services Industry?

    This industry processes and administers medical insurance policies and claims. Businesses help doctors and other healthcare providers collect payments from insurance companies and Medicare.

    Industry Products
    Policy and claims examinations
    Claims investigations
    Back-office, administrative support and consulting
    Claims processing
    Industry Activities
    Medical insurance claims submissions
    Medical insurance billing
    Medical insurance claims adjustment

    Table of Contents

    About this Industry
    Industry Definition
    Main Activities
    Similar Industries
    Additional Resources
    Industry at a Glance
    Industry Statistics Snapshot
    Industry Structure
    Executive Summary
    Industry Performance
    Executive Summary
    Key External Drivers
  • Number of physician visits
  • Number of people with private health insurance
  • Federal funding for Medicare and Medicaid
  • Number of adults aged 65 and older

  • Current Performance
  • Rebounding from setbacks
  • Healthcare reform
  • Chart: Revenue Growth

  • Industry Outlook
  • Baby boomers
  • Industry landscape
  • Table: Medical Claims Processing Services Industry Revenue Outlook

  • Industry Life Cycle
  • Life cycle reasons
  • Chart: Benchmarking - Medical Claims Processing Services Industry Lifecycle vs The Economy

  • Products & Markets
    Supply Chains
    Key Buying Industries
  • Health & Medical Insurance
  • Health & Welfare Funds
  • Healthcare and Social Assistance

  • Key Selling Industries
  • Commercial Leasing
  • Computer Stores
  • Office Furniture Manufacturing

  • Products & Services
  • Claims processing
  • Policy and claims examinations
  • Claims investigations
  • Back-office, administrative support and consulting
  • Chart: Medical Claims Processing Services Industry Products and Services Segmentation

  • Demand Determinants
  • Number of insured
  • Demographic trends
  • Healthcare reform

  • Major Markets
  • Healthcare providers
  • Private insurers
  • Government insurers
  • Chart: Major Market Segmentation for the Medical Claims Processing Services Industry

  • International Trade
    Business Locations
    Chart: Business Locations by State
    Competitive Landscape
    Market Share Concentration
    Key Success Factors
    Cost Structure Benchmarks
  • Profit
  • Wages and depreciation
  • Rent and utilities and purchases
  • Other
  • Chart: Cost Structure Benchmarking – Sector vs Medical Claims Processing Services

  • Basis of Competition
  • External competition

  • Barriers to Entry
  • Table: Barrier to Entry Checklist for the Medical Claims Processing Services Industry

  • Industry Globalization
    Major Companies
    HMS Holdings
  • Table: HMS Holdings - financial performance

  • Operating Conditions
    Capital Intensity
  • Chart: Level of Capital Intensity for the Medical Claims Processing Services Industry
  • Chart: Tools of the Trade: Growth Strategies for Success

  • Technology & Systems
    Revenue Volatility
  • Chart: Volatility vs Industry Growth

  • Regulation & Policy
    Industry Assistance
    Key Statistics
    Table: Industry Data for the Medical Claims Processing Services Industry
    Includes:
  • Industry Revenue (2007-2021)
  • Industry Gross Product (2007-2021)
  • Establishments (2007-2021)
  • Businesses (2007-2021)
  • Employment (2007-2021)
  • Wages (2007-2021)
  • Median age of the population (2007-2021)

  • Table: Annual Percentage Change for Key Industry Data
    Table: Key Ratios for Industry Key Data
    Jargon & Glossary
    Medicaid
  • A joint federal and state program that provides subsidized health insurance to low-income families and certain individuals with disabilities.
  • Medicare
  • A federal government health insurance program geared toward individuals aged 65 and older and certain younger people with disabilities.
  • Patient Protection And Affordable Care Act (Ppaca)
  • A US act signed into law by President Obama in 2010. The law provides provisions for public and private health insurance coverage.
  • Why buy this report?

    IBISWorld industry market research reports enable you to:
    • Find out about key industry trends
    • Identify threats and opportunities
    • Inform your decisions for marketing, strategy and planning
    • Quickly build competitive intelligence
    This report on Medical Claims Processing Services:
    • Provides Market Size information to assist with planning and strategic decisions.
    • Includes the necessary information to perform SWOT, PEST and STEER analysis.
    • Helps you understand market dynamics to give you a deeper understanding of industry competition and the supply chain.
    • Analyses key performance and operational metrics so that you can benchmark against your own business, that of your customers’ businesses, or your competitors’ businesses.
    The Medical Claims Processing Services market research report includes:
    • Historical data and analysis for the key drivers of this industry
    • A five-year forecast of the market and noted trends
    • Detailed research and segmentation for the main products and markets
    • An assessment of the competitive landscape and market shares for major companies
    • And of course, much more

    IBISWorld reports on thousands of industries around the world. Our clients rely on our information and data to stay up-to-date on industry trends across all industries. With this IBISWorld Industry Research Report on Medical Claims Processing Services, you can expect thoroughly researched, reliable and current information that will help you to make faster, better business decisions.

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