Ottawa, June 29, 2023 (GLOBE NEWSWIRE) -- The U.S. Payment Integrity Market is expanding as healthcare costs continue to rise, and healthcare providers and payers are seeking ways to reduce costs and improve efficiency. In addition, the increasing prevalence of fraudulent activities in the healthcare industry has also led to a growing demand for payment integrity solutions. The adoption of technology such as Artificial Intelligence (AI), Machine Learning (ML), and blockchain are expected to further boost the growth of the payment integrity market in the U.S. These technologies offer enhanced fraud detection and prevention capabilities, improved claims processing and analysis, and increased transparency in financial transactions.
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Component Landscape
The software segment is anticipated to grow at the highest CAGR from 2023 to 2032. Payment integrity artificial intelligence software aids in the detection and gathering of evidence against fraud schemes. It also aids in the extraction of useful insights and the processing of large quantities. Furthermore, the user is able to simply transfer information amongst teams in the detection of behavior-based patterns using artificial intelligence. Overall, the market for payment integrity will develop as a result of the usage of artificial intelligence in software.
The service sector is growing at the fastest rate during the projected period. Payment integrity services relate to a variety of solutions provided by leading organizations, including secure payment, payment recovery, credit balance services, overpayment identification, and coding mistake identification. Many of the leading payment integrity solution providers are continuously improving their payment integrity solutions to ensure smooth operation and fraud-free transactions. Furthermore, these services boost provider satisfaction because this technology-driven claim uses advanced algorithms with a significant possibility for payment fault detection, resulting in higher monetary recoveries. As a result of these services, payers, and providers are on the same page at the same time, and their incorporation enables speedy completion of claim evaluations and timely payment with minimum payment fraud.
U.S. Payment Integrity Market, By Component, 2022-2032 (USD Million)
| Component | 2022 | 2023 | 2032 | CAGR (2023-32) | |
| Software | 486.52 | 618.38 | 5,545.27 | 27.6 | % |
| Services | 285.74 | 361.62 | 3,119.22 | 27.1 | % |
Function Landscape
The performance management sector is anticipated to grow at a remarkable pace from 2023 to 2032. The services provided by the vendors are a big part, and performance management is a huge deal while delivering the services. The infrastructure of the payment integrity platforms should be managed, and this is done by optimization of the value received from the third-party suppliers. Furthermore, for performance management, the single platform is used in contract management, overlapping control, and performance reporting. For example, if any new user is getting onboard, then the process should be easy and rapid. Through performance management, there is a relative increase in vendor efficiency. Therefore, performance management is a critical function in the smooth running of the payment integrity business.
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U.S. Payment Integrity Market, By Function, 2022-2032 (USD Million)
| Function | 2022 | 2023 | 2032 | CAGR (2023-32) | |
| Query & Reporting | 270.29 | 342.51 | 2,989.25 | 27.2 | % |
| OLAP & Visualization | 308.90 | 392.98 | 3,552.44 | 27.7 | % |
| Performance Management | 193.07 | 244.51 | 2,122.80 | 27.1 | % |
Application Landscape
The post-payment sector is anticipated to expand at a remarkable rate from 2023 to 2032. Data mining is the extraction of hidden, unexpected, and novel rules from big data sets. Different data mining techniques and services for applications such as telephony, DNA analysis, and medical have been developed. In terms of payments, data mining developments include initiatives to investigate new methods and applications for dealing with algorithm scalability, new application areas, and complex data by utilizing visualization approaches and constraint-based data mining. Furthermore, data mining aids in the recovery of erroneous claims linked with adjudication errors, billing problems, and contract language, as well as the prevention of similar errors from occurring again. Furthermore, data mining in post-payment aids in the repair of leaks, which leads to minimizing errors.
U.S. Payment Integrity Market, By Application, 2022-2032 (USD Million)
| Application | 2022 | 2023 | 2032 | CAGR (2023-32) | |
| Pre-payment | 193.07 | 247.94 | 2,426.06 | 28.8 | % |
| Post-payment | 386.13 | 488.04 | 4,158.95 | 26.9 | % |
| FWA | 154.45 | 195.51 | 1,689.58 | 27.1 | % |
| Others | 38.61 | 48.51 | 389.90 | 26.1 | % |
Mode of Delivery Landscape
The on-premises sector is growing at the highest CAGR from 2023 to 2032. Furthermore, healthcare service providers and hospitals that strictly follow the mandates of HIPAA (Health Insurance Portability and Accountability Act) and credit card providers that follow The Payment Card Industry Data Security Standard (PCI-DSS) easily benefit from on-premises. Also, customers and partners are more easily reassured or appeased about data governance issues by employing on-premises software, thereby increasing the growth of the market.
The hybrid sector is anticipated to grow at a remarkable rate from 2023 to 2032. The necessity to react quickly and shift direction is a principle of a digital business. The corporation or enterprise seeks to merge private clouds, public clouds, as well as on-premises to obtain the flexibility needed to maintain a competitive advantage. Furthermore, the implementation of a hybrid model has strengthened collaboration across integrity payment businesses.
U.S. Payment Integrity Market, By Mode of Delivery, 2022-2032 (USD Million)
| Mode of Delivery | 2022 | 2023 | 2032 | CAGR (2023-32) | |
| On-Premise | 432.47 | 548.31 | 4,808.79 | 27.3 | % |
| Cloud-Based | 108.12 | 139.16 | 1,386.32 | 29.1 | % |
| Hybrid | 231.68 | 292.53 | 2,469.38 | 26.7 | % |
End Use Landscape
The healthcare provider sector is anticipated to grow at the fastest CAGR from 2023 to 2032. Payment integrity is critical in healthcare because it assures proper payment and accountability for qualified members. Due to changing trends, hospitals, clinics, and healthcare providers confront issues in maintaining healthcare payment integrity. Payment integrity services ensure patient and hospital openness, create confidence and knowledge of healthcare reimbursement, and decrease revenue loss.
Market Dynamics
Drivers: Growing demand for automation
Payment integrity solutions automate many of the processes involved in detecting and preventing improper payments, reducing the need for manual intervention. This automation helps improve efficiency and accuracy, further driving the adoption of payment integrity solutions.
Restraint: Unexpected Costs of Outsourcing
The market for providers of payment integrity services is also heavily consolidated. Due to this trend, payers may only have one or two vendor options accessible to them for specific services. A reduced ability to innovate and negotiate rates could be the outcome.
However, health plans have already seen internalization tactics as a potential countermeasure to the unpredictability of outsourcing expenses. Complex audits, such as IBR, DRG, and E/M evaluations, are now being carried out internally without the need for additional specialized people or a reduction in effectiveness because of technological advancements.
Related Reports
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Contactless Payment Market - The global contactless payment market accounted for USD 1.1 trillion by in 2020 and it is expanding to USD 4.60 trillion by 2027 with a CAGR of 20.01% from 2020 to 2027.
Key Market Players
- Cotiviti
- Optum / Change Healthcare
- Zelis
- Availity
- MultiPlan
- Ceris
- Cognizant
- EXL
- Performant
- Syrtis
- Varis
- ClarisHealth
- ClaimLogiq
- Rialtic
- HealthEdge
Segments Covered in the Report
By Component
- Software
- Services
By Function
- Query & Reporting
- OLAP & Visualization
- Performance Management
By Application
Pre-Payment
- Claims Editing (1st pass)
- Claims Editing (2nd, 3rd, etc.)
- Coding Validation
Post-Payment
- Complex/Clinical Provider Audit
- Coordination of Benefits (COB)
- Subrogation
- Data Mining
FWA
- Provider Fraud, Waste & Abuse
- Special Investigations
Others
- Reporting and Analytics
- Others
By Mode of Delivery
- On-Premise
- Cloud-Based
- Hybrid
By End Use
- Payers
- Healthcare Providers
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