Australia Healthcare Claims Management Market Analysis

Australia Healthcare Claims Management Market Executive Summary

The Australian healthcare claims management market is projected to grow from $320.4 Mn in 2022 to $1897.54 Mn by 2030, registering a CAGR of 24.9% during the forecast period of 2022 - 2030. In Australia, healthcare costs were $202.5 Bn, or $7,926 per person, in 2019–20. Compared to the decade average of 3.4%, the actual increase in healthcare spending was lower at 1.8%. In Australia, the government covers the majority of the cost of healthcare, but patients also foot a sizable percentage of the bill.

Healthcare providers in Australia can handle the process of getting paid by health insurance companies with the aid of the quickly expanding sector of healthcare claims management. Healthcare providers may file and handle claims more effectively, with fewer errors and better overall revenue cycle management, due to the technology solutions and services offered by healthcare claims management firms.

There is a greater need for more streamlined and effective claims management systems due to the rising demand for healthcare services in Australia, the rising number of health insurance claims, and the complexity of the claims process. In Australia, systems for managing healthcare claims frequently involve computerised claim processing, patient eligibility checking, payment processing, and rejection management. These solutions can be tailored to the unique requirements of healthcare organisations, such as hospitals, clinics, and medical practices.

Market Dynamics

Market Growth Drivers

The Australian healthcare claims management market is expected to be driven by factors such as:

1. Increase in healthcare provider consolidation- Larger healthcare organisations are acquiring smaller ones as provider consolidation in the Australian healthcare sector increases. As a result, more claims are being processed, which has increased the demand for more effective claims management solutions
2. Technological advancements- Several components of the claims management process are now able to be automated by technological developments like cloud computing and artificial intelligence. The efficiency and precision of the process have increased, which has helped the market for healthcare claims management expand
3. Regulatory changes- In Australia, the healthcare sector is extensively regulated, and the reimbursement process is governed by a number of rules and regulations. Regulations like the Medicare Benefits Schedule and the Health Insurance Act of 1973 have enhanced the demand for effective claims management solutions
4. Increase in healthcare spending- The demand for healthcare services has increased as a result of the Australian government's increased healthcare spending. The demand for healthcare claims management solutions has increased as a result of the increase in claims made by healthcare providers

Market Restraints

The following factors are expected to limit the growth of the healthcare claims management market in Australia:

1. Restricted system interoperability- Medical billing and claims management software frequently needs to interact with other software, such as electronic health records and billing software. It may be challenging to properly adopt and use healthcare claims management solutions due to the lack of interoperability across various systems
2. Data privacy and security concerns- In Australia, there are stringent laws governing data privacy and security in the healthcare sector. Healthcare claims management businesses must make sure that patient data is secure and complies with laws such as the My Health Records Act of 2012 and the Privacy Act of 1988
3. Opposition to change- Many healthcare professionals could be reluctant to use new technological solutions, preferring to continue with their manual or antiquated procedures instead. The adoption of healthcare claims management solutions may be constrained as a result
4. Cost issues- The expense of deployment and continuing maintenance may deter healthcare providers from investing in healthcare claims management technologies. This may prevent certain healthcare organisations, especially those with lesser resources, from adopting these solutions

Competitive Landscape

Key Players

• Proclaim (AUS)- a tech-savvy expert claim manager that goes above and above to offer creative outsourced claim management. It offers solutions for all types of general insurance policies, including those for professional indemnity, public and product liability, property, auto, accident and health, and other specialty lines
• Medibank (AUS)- uses Civica’s digital platform and offers a better user experience with quicker transaction completion times and rapid claim determinations. Additionally, it permits fund organisations to speak with members directly while making the claim and provides more security via tokens and encryption
• Riskware (AUS)- based in Melbourne, offers various products and services including claims management. It provides cutting-edge case management tools, great transparency, powerful return-to-work and rehabilitation features, and mechanisms for managing compensation
• Cognizant- an international company that offers solutions for processing medical claims, and operational, digital, and consulting services. The primary technical areas that are transforming business include the cloud, IoT, AI, and software engineering
• Accenture- a multinational professional services firm that offers clients in Australia and other nations services for managing medical claims. Customer support, fraud and abuse detection, analytics and reporting, as well as claims processing and management, are all included in Accenture's healthcare management services

Notable Deals

September 2020: With the help of the collaboration between Civica, Medibank, and LanternPay, private health insurance claims were transformed. Through this collaboration, the new cloud solution gives Medibank clients a better user experience, faster transaction funding, and instant claim judgements. Additionally, it permits fund organisations to speak with members directly while making the claim and provides more security via tokens and encryption.