According to Arizton’s latest research report, the US healthcare denial management market is growing at a CAGR of 9.67% during 2023-2030.
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Report Scope:
Market Size (2030): $8.93 Billion
Market Size (2024): $5.13 Billion
CAGR (2023-2030): 9.67%
Historic Year: 2021-2023
Base Year: 2024
Forecast Year: 2025-2030
Market Segmentation: Denials Type, System Type, Delivery Mode, End-User, Healthcare Providers, and Region
Geographical Analysis: TheU.S. (West, Midwest, Northeast, and South)
The US healthcare denial management market is highly competitive, with numerous leading, growing, and emerging players operating nationwide. Prominent companies such as UnitedHealth Group and McKesson dominate the market by focusing on expanding their product portfolios, improving efficiency, and strengthening market positions. Vendors consistently innovate, developing new technologies and solutions to attract a broader consumer base. Strategic collaborations and partnerships among key players further intensify competition. Rapidly growing companies like eClinicalWorks, Experian, and Veradigm LLC (Allscripts Healthcare Solutions) stand out for their extensive geographical presence, diverse offerings, and emphasis on innovation and research. These strategies have enabled major players to secure higher revenue shares in the market.
Growing Demand for Healthcare Denial Management Solutions in the US
The healthcare providers segment holds a dominant position in the US healthcare denial management market, driven by its critical role in addressing payment denials from insurance companies. This segment includes hospitals, clinics, physician offices, and other care facilities, all of which face increasing challenges related to insurance claim denials.
Denial rates and associated costs are a major concern for healthcare providers, prompting a rising demand for advanced denial management solutions. Hospitals are heavily impacted, with significant resources being spent on overturning denial claims. Most of these claims are eventually paid, but not without considerable time and expense on appeals. This highlights the need for streamlined and automated denial management systems.
The US healthcare sector is characterized by its extensive infrastructure, including thousands of hospitals, clinics, and physician offices, which creates substantial opportunities for denial management providers. Despite the high level of digitization in hospitals, many facilities have yet to adopt automated denial systems, leading to inefficiencies and operational challenges. This gap presents lucrative growth prospects for denial management solutions as healthcare providers increasingly seek automation to address these issues.
West Region: A Key Player in the U.S. Healthcare Denial Management Market
In 2024, the West region led the US healthcare denial management market, accounting for the largest market share and revenue contribution. Comprising states like California, Arizona, and Washington, the region exhibits high demand for denial management due to substantial healthcare spending and elevated denial rates. The Pacific area has consistently recorded the highest denial rates since the COVID-19 pandemic, driving the need for denial management solutions. Similarly, the Mountain region has seen steady growth in denial rates, presenting opportunities for market expansion. States such as Arizona and New Mexico face some of the highest denial rates, further boosting demand for these solutions. With over 1,000 advanced hospitals offering healthcare claim services, the region is expected to maintain strong growth in automated denial management adoption.
Recent Vendor Activities
- In 2022, UnitedHealth Group’s Optum division completed a $13 billion acquisition of Change Healthcare, one of the largest players in the market. This significant transaction solidified UnitedHealth Group’s position in the industry.
- In 2023, Allscripts Healthcare rebranded itself as Veradigm LLC.
- In 2021, Kareo, a provider of comprehensive healthcare software, merged with Tebra and rebranded under the Tebra name.
- In 2021, MRO acquired Cobius Healthcare Solutions, a leading developer of healthcare denial management solutions.
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Key Vendors
- United HealthGroup
- McKesson
- eClinicalWorks
- Experian
- Veradigm LLC
- 24/7 Medical Billing Services
- 3D SOLUTIONS LLC
- 3Gen Consulting
- 4D Global
- Access Healthcare
- Acrologic Business Solutions
- AdvancedMD
- AdvantEdge Healthcare Solutions
- Advantum Health
- CorroHealth, Inc. - (Aergo Solutions)
- Alaska Billing Services
- AllianceMed, LLC
- BillingParadise
- Bizmatics, Inc
- CareCloud
- ChartLogic
- Cognizant
- Coronis Health
- Craneware
- Credit Management Company
- CureMD Healthcare
- Data Marshall
- EverHeath Solution, Inc. (DrChrono)
- EHealthSource
- Greenway Health
- Golden West Medical Billing
- InSync Healthcare Solutions
- IntelliRCM
- iSalus
- Tebra Technologies
- Netsmart Technologies, Inc. (McBee)
- MedEx Medical Billing
- Medforce Technologies
- Medical Billers and Coders
- Medmecs Billing Services
- MGSI
- MRO
- NXGN Management
- OSP
- Persistent Systems
- PMMC
- Promantra
- Quadax, Inc
- QWay Healthcare
- R1
- Resolutions Billing
- Revele
- Right Medical Billing
- Savista
- Superior Medical Management
- TriMed Technologies
- Vee Technologies
- RevenueXL
- Vitruvian MedPro
- Waystar
Segmentation & Forecast
Denials Type
- Soft Denials
- Hard Denials
System Type
- Integrated
- Standalone
Delivery Mode
- Web & Cloud-based
- On-premises
End-Users
- Healthcare Providers
- Hospitals
- Physician Offices
- Other Healthcare Providers
- Healthcare Payers
Healthcare Providers
- Hospitals
- Physician Offices
- Others
Regions
- West
- Mid-west
- Northeast
- South
The Arizton Advisory & Intelligence market research report provides valuable market insights for industry stakeholders, investors, researchers, consultants, and business strategists aiming to gain a thorough understanding of the US healthcare denial management market. Request for Free Sample to get a glance of the report now: https://www.arizton.com/market-reports/us-healthcare-denial-management-market
What Key Findings Our Research Analysis Reveals?
What are the factors driving the U.S. healthcare denial management market growth?
What is the expected growth rate of the U.S. healthcare denial management market?
How big is the U.S. healthcare denial management market?
Which region will have the highest growth in the U.S. healthcare denial management market?
Who are the major players in the U.S. healthcare denial management market?
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