# Claims Management * **Definition:** The process of managing and processing insurance claims for reimbursement from insurance companies, which includes submitting, tracking, and resolving claims to ensure accurate and timely payments within the healthcare industry. * **Taxonomy:** Healthcare Topics / Claims Management ## News * Selected news on the topic of **Claims Management**, for healthcare technology leaders * 3.2K news items are in the system for this topic * Posts have been filtered for tech and healthcare-related keywords | Date | Title | Source | | --- | --- | --- | | 4/28/2025 | [**AI In Healthcare Market Size to Reach $187.7 Billion by 2030 at CAGR 38.5**](https://finance.yahoo.com/news/ai-healthcare-market-size-reach-140500267.html) | [[Yahoo Finance]] | | 4/21/2025 | [**Xsolis AI solutions and services have saved Beacon Health System more than $95 million**](https://www.fiercehealthcare.com/sponsored/xsolis-ai-solutions-and-services-have-saved-beacon-health-system-more-95-million) | [[FierceHealthcare]] | | 4/19/2025 | [**HIMSS Changemaker recommends investing time to mentor - Healthcare Finance News**](https://www.healthcarefinancenews.com/video/changemaker-recommends-investing-time-mentor) | [[Healthcare Finance]] | | 4/16/2025 | [**Black Book Expands 2025 RCM KPI Framework to Capture AI, Outsourcing and Financial ...**](https://www.newswire.com/news/black-book-expands-2025-rcm-kpi-framework-to-capture-ai-outsourcing-22514396) | [[Newswire]] | | 4/7/2025 | [**ScribeEMR: Revolutionizing Healthcare Through Innovative Solutions**](https://www.beckershospitalreview.com/innovation/scribeemr-revolutionizing-healthcare-through-innovative-solutions/) | [[Beckers Hospital Review]] | | 3/3/2025 | [**FinThrive and HIMSS Survey Reveals Cybersecurity Funding is a Top Challenge for Smaller Hospitals**](https://www.prnewswire.com/news-releases/finthrive-and-himss-survey-reveals-cybersecurity-funding-is-a-top-challenge-for-smaller-hospitals-302388761.html) | [[PR Newswire]] | | 1/31/2025 | [**Why combining human expertise and technology is imperative in modernizing claims management**](https://www.modernhealthcare.com/finance/human-ai-edge-essential-modernizing-claims-management) | [[Modern Healthcare]] | | 1/29/2025 | [**Navigating Healthcare Complexities: Leveraging Enterprise Software for Payer and Provider Success**](https://www.beckershospitalreview.com/legal-regulatory-issues/navigating-healthcare-complexities-leveraging-enterprise-software-for-payer-and-provider-success.html) | [[Beckers Hospital Review]] | | 1/13/2025 | [**Red Sky Health Secures $3M in Seed Funding to Revolutionize Healthcare Claims Management**](https://www.prnewswire.com/news-releases/red-sky-health-secures-3m-in-seed-funding-to-revolutionize-healthcare-claims-management-302348695.html) | [[PR Newswire]] | | 12/20/2024 | [**Comprehensive Analysis of the Medical Claims Management Solutions Market (2024-2031)**](https://www.linkedin.com/pulse/comprehensive-analysis-medical-claims-management-solutions-kofke) | [[Linkedin]] | | 12/2/2024 | [**Why RCM Companies Are Modernizing Their Environments**](https://healthtechmagazine.net/article/2024/12/why-rcm-companies-are-modernizing-their-environments) | [[HealthTech Magazine]] | | 11/27/2024 | [**Robotic Process Automation in Healthcare Market Surges to USD 9.5 Billion by 2030 ...**](https://www.prnewswire.com/news-releases/robotic-process-automation-in-healthcare-market-surges-to-usd-9-5-billion-by-2030--propelled-by-25-9-cagr---verified-market-reports-302317393.html) | [[PR Newswire]] | | 11/11/2024 | [**SunCar Technology and Wuhan JIDU Join Forces to Revolutionize Auto Insurance ... - PR Newswire**](https://www.prnewswire.com/news-releases/suncar-technology-and-wuhan-jidu-join-forces-to-revolutionize-auto-insurance-with-nationwide-intelligent-platform-302300794.html) | [[PR Newswire]] | | 10/28/2024 | [**Optimize RCM and claims management with modern technology - Healthcare IT News**](https://www.healthcareitnews.com/resource/optimize-rcm-and-claims-management-modern-technology) | [[Healthcare IT News]] | | 10/17/2024 | [**Healthcare Payer Services Business Research Report 2023-2024 & 2030 - Growth in Telehealth and Virtual Care Services Expands the Scope of Payer Services - ResearchAndMarkets.com**](http://www.businesswire.com/news/home/20241017425707/en/Healthcare-Payer-Services-Business-Research-Report-2023-2024-2030---Growth-in-Telehealth-and-Virtual-Care-Services-Expands-the-Scope-of-Payer-Services---ResearchAndMarkets.com/?feedref=JjAwJuNHiystnCoBq_hl-RLXHJgazfQJNuOVHefdHP-D8R-QU5o2AvY8bhI9uvWSD8DYIYv4TIC1g1u0AKcacnnViVjtb72bOP4-4nHK5ieT3WxPE8m_kWI77F87CseT) | [[Business Wire]] | | 10/17/2024 | [**Healthcare Payer Services Business Research Report 2023-2024 & 2030 - Growth in Telehealth and Virtual Care Services Expands the Scope of Payer Services - ResearchAndMarkets.com**](http://www.businesswire.com/news/home/20241017425707/en/Healthcare-Payer-Services-Business-Research-Report-2023-2024-2030---Growth-in-Telehealth-and-Virtual-Care-Services-Expands-the-Scope-of-Payer-Services---ResearchAndMarkets.com/?feedref=JjAwJuNHiystnCoBq_hl-Q-tiwWZwkcswR1UZtV7eGe24xL9TZOyQUMS3J72mJlQ7fxFuNFTHSunhvli30RlBNXya2izy9YOgHlBiZQk2LOzmn6JePCpHPCiYGaEx4DL1Rq8pNwkf3AarimpDzQGuQ==) | [[Business Wire]] | | 10/15/2024 | [**Healthcare EDI Market to Hit USD 7.11 Billion by 2029 with 9.7AGR - PR Newswire**](https://www.prnewswire.com/news-releases/healthcare-edi-market-to-hit-usd-7-11-billion-by-2029-with-9-7-cagr--marketsandmarkets-302276018.html) | [[PR Newswire]] | | 10/10/2024 | [**Healthcare Payer Services Business Research Report 2024: Global Market to Surpass $100 ...**](https://finance.yahoo.com/news/healthcare-payer-services-business-research-141400536.html) | [[Yahoo Finance]] | | 10/10/2024 | [**The Mechanic Group, a Division of Specialty Program Group LLC, Announces Partnership ...**](https://www.prnewswire.com/news-releases/the-mechanic-group-a-division-of-specialty-program-group-llc-announces-partnership-with-palomar-for-best-in-class-security-alarm--investigator-program-302272343.html) | [[PR Newswire]] | | 10/8/2024 | [**France Insurance Claims Management Solution Market By Application - Future Projections 2031**](https://www.linkedin.com/pulse/france-insurance-claims-management-solution-market-ztmie) | [[Linkedin]] | | 9/11/2024 | [**Healthcare Claims Management Solutions Market Share, Trend Analysis, Key Drivers, Size ...**](https://whatech.com/og/markets-research/medical/877416-healthcare-claims-management-solutions-market-share-trend-analysis-key-drivers-size-and-forecast-to-2033.html) | whatech.com | | 9/3/2024 | [**Healthcare Claims Management Market to Reach USD 220.49 Billion by 2032 As Revealed ...**](https://www.whatech.com/og/markets-research/medical/874667-healthcare-claims-management-market-to-reach-usd-220-49-billion-by-2032-driven-by-growing-adoption-of-integrated-and-cloud-based-solutions.html) | whatech.com | | 8/7/2024 | [**Healthcare Revenue Cycle Management (RCM) Software Market size is set to grow by USD ...**](https://www.prnewswire.com/news-releases/healthcare-revenue-cycle-management-rcm-software-market-size-is-set-to-grow-by-usd-34-8-billion-from-2024-2028--growing-need-for-reducing-revenue-leakage-in-healthcare-system-boost-the-market-technavio-302215625.html) | [[PR Newswire]] | | 7/10/2024 | [**Healthcare BPO Market: $395.3B to $626.6B Growth Forecast (2024-2029) - MarketsandMarkets™**](https://www.globenewswire.com/news-release/2024/07/10/2911104/0/en/Healthcare-BPO-Market-395-3B-to-626-6B-Growth-Forecast-2024-2029-MarketsandMarkets.html) | [[Globe Newswire]] | | 6/17/2024 | [**Healthcare BPO Market Anticipates USD 626.6 Billion by 2029 with 9.7% CAGR - MarketsandMarketstm**](https://www.lelezard.com/en/news-21422134.html) | lelezard.com | ## Topic Overview (Some LLM-derived content — please confirm with above primary sources) ### Key Players - **Med Claims Compliance**: A company integrating AI technology with human oversight to enhance accuracy and streamline claims management workflows. - **ClarisHealth**: Focuses on claims management solutions, particularly for out-of-network claims. - **Guidewire**: A leader in P&C claims management systems, known for its ClaimCenter product, which integrates advanced analytics and automation for improved claims processing. - **ServiceNow**: A cloud-based platform recognized for its strong strategy in P&C claims management, focusing on enhancing claimant experiences and addressing legacy system challenges. - **Spear Technologies**: Provides claims management solutions with a focus on subrogation recovery processes. - **Medlogix**: Offers technology-driven medical claims management solutions. - **Change Healthcare**: One of the largest medical claim clearinghouses in the US, recently impacted by a cyberattack affecting claims processing. - **CLARA Analytics**: Offers AI-driven solutions for claims management, including predictive analytics and generative AI to optimize claims processes. - **Xsolis**: Utilizes AI solutions to improve claims management and operational efficiency. - **Waystar**: Ranked highest for inpatient hospital claims management solutions. - **Expion Health**: Utilizes advanced data analytics for managing out-of-network claims. - **Oracle**: Provides integrated cloud applications and platform services for healthcare claims management. - **Effective Health Systems**: Launched BaseLine.RPT, an AI-powered solution to automate claims processing in the workers' compensation sector. - **Omega Healthcare**: A leader in revenue cycle management operations, recognized for its advanced technology solutions in claims management. - **Red Sky Health**: An emerging player utilizing AI to optimize healthcare claims management and address insurance claim denials. - **FinThrive, Inc.**: Developed a claims management solution integrated with Oracle Health to streamline billing processes. - **Availity**: The nation's largest real-time health information network, offering solutions for revenue cycle management and claims processing. - **Bluespine**: An AI-driven claims cost reduction platform that raised $7.2 million to help self-insured employers tackle healthcare overspending. ### Partnerships and Collaborations - **Eastern Alliance and CLARA Analytics**: Partnership to improve claims management efficiency and medical outcomes for injured workers. - **Altus Nova Technologies and FinMed**: Collaboration to automate error correction and streamline claim submissions. - **George Hills Company and Spear Technologies**: Implemented SpearClaims to modernize subrogation recovery processes. - **ClarisHealth and Expion Health**: Partnered to enhance out-of-network claims management through integrated services. - **Medlogix and ReviewWorks**: The acquisition enhances Medlogix's capabilities in medical claims management. - **Sanford Health and Availity**: Partnered to implement Availity Essentials Pro for revenue cycle management, enhancing claims and payment processing after a cyberattack. - **Altus Nova and FinMed**: Collaboration to automate healthcare billing processes and enhance claim submissions. - **Vitesse and Five Sigma**: Partnership aimed at modernizing claims payouts in the insurance industry through enhanced automation. - **Bluespine and major employers**: Partnering with companies like Mattel and Alliant Insurance Services to address medical overbilling. - **FinThrive and Oracle Health**: Joint development effort to enable API integration for streamlined claims management. - **Careviso and XiFin**: Strategic alliance to enhance operational efficiencies for diagnostic laboratories through integration of prior authorization services. - **HealthEdge and Codoxo**: Formed a strategic partnership to enhance payment integrity solutions for healthcare payers, integrating their technologies to streamline claims processing. - **Availity and Iodine Software**: Collaboration to integrate clinical documentation integrity into revenue cycle management. - **Cibolo Health and TruBridge**: Collaboration to enhance financial optimization services for independent rural hospitals and medical practices. - **Arintra and Epic**: Integration of Arintra's GenAI engine into Epic's systems for fully autonomous coding, enhancing claims accuracy. - **TruBridge and Cibolo Health**: TruBridge selected as a preferred partner to enhance financial optimization services for independent rural hospitals. - **TA Associates and Vee Healthtek**: Strategic growth investment aimed at improving technology capabilities and expanding service offerings in healthcare. - **Texas Organization of Rural and Community Hospitals and Epic**: A potential partnership aimed at creating a Unified Care Infrastructure to address rural healthcare challenges. - **University of North Carolina-Chapel Hill**: Collaborating on the Cancer Identification and Precision Oncology Center (CIPOC) to enhance cancer diagnosis and treatment through AI technology. - **Osigu and Visa**: Partnership to enhance real-time payment solutions for healthcare providers in Latin America. ### Innovations, Trends, and Initiatives - **Claims Management Software Segment**: Projected to experience the highest growth rate due to rising healthcare claims volume. - **Value-based Care**: Increasing focus on outcomes-based reimbursement models impacting claims management. - **AI in Claims Management**: AI is increasingly recognized as a valuable tool for reducing billing errors and improving claims processing speed. - **AI and Automation in Claims Management**: The integration of AI and machine learning technologies to streamline claims processing, improve compliance, and reduce administrative burdens. - **AI and Automation**: Increasing adoption of AI and robotic process automation (RPA) to enhance claims management efficiency. - **Cloud-Based Solutions**: The COVID-19 pandemic has accelerated the adoption of cloud-based claims management systems, improving efficiency and collaboration. - **Automation and Compliance**: Integration of AI and automation in claims management processes to enhance operational efficiency and compliance. - **AI-powered Claims Analytics**: Utilization of artificial intelligence to enhance efficiency and accuracy in claims processing. - **Telehealth Expansion**: Driving demand for efficient claims management solutions. - **Automation of Claims Processing**: Solutions like BaseLine.RPT and AKASA Medical Coding are automating critical functions in claims management to reduce administrative burdens. - **Data Analytics for Claims Accuracy**: Investments in data analytics platforms are recommended to improve claims accuracy and optimize coding practices. - **Generative AI**: Expected to transform claims management by automating processes such as prior authorizations and claims processing, enhancing efficiency and reimbursement. - **Apprio IDP**: An intelligent denial prevention solution utilizing AI and automation to streamline the claims lifecycle and reduce denials. - **AI in Claims Processing**: Increasing use of AI by payers to enhance claims processing efficiency, leading to a rise in claims denials. - **Blockchain Technology**: Adoption for secure and transparent claims processing. - **Healthcare BPO Market Growth**: The healthcare BPO market is projected to grow significantly, driven by the demand for claims management services. - **Business Process Outsourcing (BPO)**: Healthcare payers are increasingly outsourcing claims processing and billing to improve efficiency and reduce costs. ### Challenges and Concerns - **Complexity of Claims Management**: EHR systems struggle with managing complex claims effectively, particularly with specialized claims involving multiple payers. - **Claims Denials**: The healthcare system faces significant challenges with high rates of claim denials, necessitating improved processes and technology to manage these issues. - **Complexity of Healthcare Reimbursement**: Increasing complexity necessitates advanced claims management solutions to navigate regulatory changes. - **Claim Denials**: The use of AI by payers is leading to increased claim denials, necessitating healthcare systems to improve their revenue cycle processes. - **Legacy Systems**: Challenges in modernizing outdated IT systems that hinder efficient claims processing. - **Claim Denials and Errors**: Increased claim denials due to incorrect coding and insufficient documentation create administrative burdens for healthcare providers. - **Administrative Costs**: Inefficiencies in claims submission and payment processes lead to increased operational costs. - **Billing Errors**: Despite advancements, challenges remain in fully realizing the benefits of AI in claims processing. - **Rising Denial Rates**: Denial rates for healthcare claims have increased, complicating revenue collection and increasing administrative overhead. - **Investment and Training Costs**: Challenges such as initial investment costs, staff training, and ethical concerns hinder the widespread adoption of AI in claims management. - **Administrative Errors**: Significant contributor to medical errors, highlighting the need for improved digital accuracy in claims processing. - **Cybersecurity Threats**: The Change Healthcare cyberattack highlighted vulnerabilities in claims processing and the need for improved security measures. - **Interoperability Issues**: Lack of interoperability among healthcare systems complicates claims processing and payment reconciliation. - **Administrative Burdens**: Healthcare organizations face increased administrative burdens due to rising denial rates and the need for appeals and resubmissions. - **Administrative Complexity**: The complexity of payer requirements is increasing, leading to higher denial rates and administrative burdens for healthcare providers. - **Medical Billing Errors**: Studies indicate that up to 80% of medical bills contain errors, primarily due to incorrect coding, leading to financial discrepancies. - **Data Privacy**: As AI adoption accelerates, insurers must address data privacy challenges and ensure compliance with regulations. ## Related Topics [[Claims Processing]]; [[Claims Reviews]]; [[Case Management]]; [[Claims Denials]]