Healthcare EDI Market by Component (Services and Solutions), by Delivery Mode (Web & Cloud-based EDI, EDI VAN, Point-to-Point EDI, and Mobile EDI), by Transaction Type (Claims Management and Healthcare Supply Chain), by End User (Healthcare Providers, Healthcare Payers, Medical Device & Pharmaceutical Industries, and Pharmacies), and by Region - Size, Share, Outlook and Opportunity Analysis 2018 - 2026

  • To Be Published : Aug 2018 |
  • Format : CMI Insight PPT Format CMI Insight PDF Format

Healthcare domain has critical importance of the data management, as medical records and patient history play significant role in medical claims and reimbursement. Electronic Data Interchange (EDI) is the software medium for transaction of data among various healthcare providers and payers via computer systems. Organizer can process and track claims through the entire billing cycle via EDI service.

The healthcare industry explored EDI to address the challenges of reducing healthcare cost and replacing paper-based transaction with standard electronic transaction. Moreover, government acts such as Health Insurance Portability Act of 1996 (HIPAA) created standards to achieve administrative simplicity in healthcare industry.

The benefits of EDI over conventional method of data interchange is the major factor driving the healthcare EDI market growth. EDI reduces data entry time, improves accuracy, reduce operational cost, and also reduce the rework. Such key features of EDI software supports the growth of healthcare EDI market.

Healthcare EDI Market Dynamics

Increasing digitization and paperless office is enhancing the growth of healthcare EDI market. Conventionally, data transfer was subjected to paper-based communication, increasing the chance of human error and making the workflow cumbersome. Henceforth, EDI is an essential component for creating administrative efficiencies by reducing time and significant cost saving.

Healthcare EDI market is propelled by increasing adoption of EDI facilities in order to accelerate financial performance and profitability for healthcare payers and providers. For instance, according to GE Healthcare, the Centricity EDI Service of GE Healthcare employs more than 2,100 healthcare providers to manage around 588 million transaction annually. EDI is adopted to reduce the claim rejection and denials as well as reduce time requirement for submission and remission of claims.

Furthermore, the use of EDI serves important role in insurance claims and documentation by streamlining the reimbursement process for healthcare payers. However, high cost of EDI software and its application are expected to be the major factor hindering the healthcare EDI market growth over the forecast period.

Healthcare EDI Market - Regional Analysis

Regional segmentation of healthcare EDI market by Coherent Market Insights include North America, Latin America, Europe, Asia Pacific, Middle East, and Africa. North America healthcare EDI market holds dominant position in the global healthcare EDI market, owing to the dominant position is the advanced healthcare infrastructure of the region. Moreover, increasing adoption of technologically advanced facilities to improve the healthcare facilities are expected to boost the regional healthcare EDI market growth. However, Asia Pacific healthcare EDI market is expected to witness fastest growth attributed to improving healthcare infrastructure in the region, thereby providing the market opportunity for the market players to penetrate in Asia Pacific region.

Healthcare EDI Market – Competitive Analysis

Healthcare EDI market is dominated by the few major players such as Optum Inc., Dell Technologies Inc., General Electric Company, Emdeon Inc., The SSI Group, LLC, ZirMed, Inc., Tallan, Inc., Quadax, and Allscripts Healthcare Solutions Inc.

The market player involved in healthcare EDI market are focused on improving the EDI facilities by using various strategies. For instance, in 2015, Medical Transcription Billing, Corp., a healthcare information technology company, acquired three divisions of QHR Corporation, Canada-based healthcare technology company. The QHR Corporation is involved in healthcare clearinghouse, Electronic Data Interchange (EDI), and revenue cycle management divisions.

Moreover, in 2016, Tallan Inc., combined with Dell Boomi Platform for its T-Connect extensible framework in order to enhance high data throughput and cop up with ever changing EDI requirement. In same year, Optum Inc., partnered with Availity, healthcare information Technology Company to improve the accuracy of health insurance claims and reduce the errors.

Healthcare EDI Market - Taxonomy

On the basis of component, the healthcare EDI market is segmented into:

  • Services
  • Solutions

On the basis of delivery mode, the healthcare EDI market is segmented into:

  • Web & Cloud-based EDI
  • EDI VAN
  • Point-to-Point EDI
  • Mobile EDI

On the basis of transaction type, the healthcare EDI market is segmented into:

  • Claims Management
    • Claims Submission
    • Claim Status
    • Eligibility Verification
    • Payment Remittance
    • Referral Certification & Authorization
    • Claim Payments
    • Others
  • Healthcare Supply Chain

On the basis of end user, the healthcare EDI market is segmented into:

  • Healthcare Providers
  • Healthcare Payers
  • Medical Device & Pharmaceutical Industries
  • Pharmacies

On the basis of region, the healthcare EDI market is segmented into:

  • North America
  • Europe
  • Latin America
  • Asia Pacific
  • Middle East
  • Africa

Research Methodology

Coherent Market Insights followsa comprehensive research methodology focused on providing the most precise market analysis. The company leverages a data triangulation model which helps company to gauge the market dynamics and provide accurate estimates. Key components of the research methodologies followed for all our market reports include:

  • Primary Research (Trade Surveys and Experts Interviews)
  • Desk Research
  • Proprietor Data Analytics Model

In addition to this, Coherent Market Insights has access to a wide range of the regional and global reputed paid data bases, which helps the company to figure out the regional and global market trends and dynamics. The company analyses the industry from the 360 Degree Perspective i.e. from the Supply Side and Demand Side which enables us to provide granular details of the entire ecosystem for each study. Finally, a Top-Down approach and Bottom-Up approach is followed to arrive at ultimate research findings.


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Coherent Market Insights desk research is based on a principle set of research techniques:

  • National level desk research: It Includes research analysis of regional players, regional regulatory bodies, regional trade associations, and regional organization.
  • Multinational level desk research: The research team keeps a track of multinational players, global regulatory bodies, global trade associations, and global organization.

Coherent Market Insights has a large amount of in-house repository of industry database. This is leveraged as a burner for initiating a new research study. Key secondary sources include:

  • Governmental bodies, National and international social welfare institutions, and organizations creating economic policies among others.
  • Trade association, National and international media and trade press.
  • Company Annual reports, SEC filings, Corporate Presentations, press release, news, and specification sheet of manufacturers, system integrators, brick and mortar - distributors and retailers, and third party online commerce players.
  • Scientific journals, and other technical magazines and whitepapers.
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Preliminary Data Mining

The raw data is obtained through the secondary findings, in house repositories, and trade surveys. It is then filtered to ensure that the relevant information including industry dynamics, trends, and outlook is retained for further research process.

Data Standardization:

Holistic approach is used to ensure that the granular and uncommon parameters are taken into consideration to ensure accurate results. The information from the paid databases are further combined to the raw data in order to standardize it.

Coherent Statistical model

We arrive at our final research findings through simulation models. Coherent Data Analytics Model is a statistical tool that helps company to forecast market estimates. Few of the parameters considered as a part of the statistical model include:

  • Micro-economic indicators
  • Macro-economic indicators
  • Environmental indicators
  • Socio-political indicators
  • Technology indicators

Data Processing

Once the findings are derived from the statistical model, large volume of data is process to confirm accurate research results. Data analytics and processing tools are adopted to process large chunk of collected informative data. In case, a client customizes the study during the process, the research finding till then are benchmarked, and the process for new research requirement is initiated again.

Data Validation

This is the most crucial stage of the research process. Primary Interviews are conducted to validate the data and analysis. This helps in achieving the following purposes:

  • It provides first-hand information on the market dynamics, outlook, and growth parameters.
  • Industry experts validates the estimates which helps the company to cement the on-going research study.
  • Primary research includes online surveys, face-to face interviews, and telephonic interviews.

The primary research is conducted with the ecosystem players including, but not limited to:

  • Raw Material Suppliers
  • Manufacturers
  • System Integrators
  • Distributors
  • End-users

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