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Healthcare EDI Market worth $4.42 billion by 2031 | MarketsandMarkets™

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DELRAY BEACH, Fla., June 15, 2026 /PRNewswire/ — According to MarketsandMarkets™, the Healthcare EDI Market is projected to grow from about USD 2.77 billion in 2026 to USD 4.42 billion by 2031, at a CAGR of 9.8%.

Browse 350 market data Tables and 60 Figures spread through 400 Pages and in-depth TOC on “Healthcare EDI Market – Global Forecast to 2031”

Healthcare EDI Market Size & Forecast:

Market Size Available for Years: 2025–20312026 Market Size: USD 2.77 billion2031 Projected Market Size: USD 4.42 billionCAGR (2026–2031): 9.8%

Healthcare EDI Market Trends & Insights:

The solutions segment is expected to register the highest CAGR of 10.1% during the forecast period.The cloud-based segment is expected to register the highest CAGR of 10.0% during the forecast period.North America dominated the market in 2025 with a share of 59.0%.

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The growth is driven by the rising need to automate payer-provider transactions such as claims submission, eligibility and benefits verification, prior authorization, claim status checks, payment remittance, and enrollment-related data exchange. Healthcare organizations are moving away from paper forms, phone calls, fax-based approvals, and manual billing work because these processes increase errors, delay payments, and add cost to revenue cycle operations. Supportive regulations around standardized electronic transactions, data security, interoperability, and prior authorization automation are also pushing providers and payers to adopt EDI platforms. The growing use of cloud-based EDI, managed EDI services, clearinghouse networks, and API-enabled data exchange is further supporting market growth. On the other hand, high integration costs, legacy hospital and payer systems, cybersecurity concerns, and different payer-specific transaction rules continue to slow adoption among smaller providers and regional healthcare organizations.

The cloud-based deployment segment is expected to register the fastest growth in the healthcare EDI market during the forecast period.

Based on deployment model, the healthcare EDI market is segmented into cloud-based, on-premises, and hybrid models. Among these, the cloud-based segment is expected to show the fastest growth during the forecast period. This is mainly because healthcare providers, payers, clearinghouses, and pharmacies are looking for EDI systems that are easier to deploy, less costly to maintain, and faster to scale. Cloud-based EDI also supports faster updates when payer rules, compliance needs, or transaction standards change. This is important because healthcare organizations need to exchange data securely and accurately with many payers and trading partners. In addition, cloud platforms make it easier to monitor transactions, detect errors, manage exceptions, and support real-time or near-real-time data exchange. Small and mid-sized providers are also adopting cloud-based EDI because it reduces upfront infrastructure costs and allows them to access advanced EDI capabilities through subscription-based models. As healthcare systems continue to modernize revenue cycle workflows and move toward API-enabled and interoperable data exchange, the cloud-based segment is expected to remain the most active deployment model in the market.

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The VAN/clearinghouse-based EDI segment held the largest share of the healthcare EDI market in 2025.

Based on connectivity mode, the healthcare EDI market is segmented into VAN/clearinghouse-based EDI, point-to-point EDI, web portal-based EDI, API-enabled EDI, and others. In 2025, the VAN/clearinghouse-based EDI segment accounted for the largest share, as many hospitals, clinics, ambulatory surgical centers, and diagnostic centers prefer using clearinghouses instead of building direct connections with every payer. This approach makes payer connectivity easier, reduces administrative burden, and improves transaction visibility. VAN/clearinghouse-based EDI also supports claim scrubbing, transaction validation, payer-specific edits, remittance routing, and status tracking, which are important for smooth revenue cycle operations. Moreover, many providers still work with multiple insurance companies, each having different rules and formats, making clearinghouses useful for standardizing communication. While API-enabled EDI and cloud-based workflows are growing quickly, VAN/clearinghouse-based EDI remains the largest connectivity mode because it is already deeply embedded in healthcare billing, claims, and reimbursement processes.

North America held the largest share in the global healthcare EDI market in 2025.

North America held the largest share of the global healthcare EDI market in 2025. This is mainly due to the region’s mature healthcare IT infrastructure, high insurance coverage, large claims volume, and strong use of electronic transactions between providers and payers. The US is the key market in North America, as hospitals, clinics, payers, clearinghouses, pharmacies, and billing service providers widely use EDI for claims submission, eligibility and benefits verification, claim status checks, prior authorization, electronic remittance, and payment posting. Regulations around standardized healthcare transactions and data privacy have also encouraged wider use of EDI platforms across the region. Healthcare EDI adoption in North America is not limited to large hospitals. Ambulatory surgical centers, diagnostic laboratories, specialty clinics, dental practices, and pharmacies are also using EDI to reduce manual paperwork, lower billing errors, and speed up reimbursement. The growing shift toward cloud-based EDI, managed EDI services, and API-enabled workflows is further supporting market growth in the region.

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Top Companies in Healthcare EDI Market:

The Top Companies in Healthcare EDI Market include Optum, Inc. (US), Availity, LLC (US), Waystar Holding Corp. (US), Cognizant Technology Solutions Corporation (US), Experian Information Solutions, Inc. (US), Inovalon Holdings, Inc. (US), athenahealth Group, Inc. (US), Veradigm Inc. (US), The SSI Group, LLC (US), Quadax, Inc. (US), IBM (US), Oracle Corporation (US), NTT DATA Group Corporation (Japan), Comarch S.A. (Poland), Axway Software, a 74Software company (France), Boomi, LP (US), TrueCommerce, Inc. (US), PLEXIS Healthcare Systems, Inc. (US), Epicor Software Corporation (US), and Cleo Communications LLC (US).

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SQAIRZ Launches SQAIRZ Medical

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New Division Introduces the First Integrated Balance & Stability Platform to Help Combat Fall Risk and Support Lifelong Movement, Vitality and Independence

WINDHAM, N.H., Sept. 10, 2026 /PRNewswire/ — SQAIRZ, the biomechanically driven performance footwear company built on the belief that performance starts where you stand, today announced the launch of SQAIRZ Medical, extending the company’s expertise in stability and human movement into one of the most significant health challenges facing an aging population: fall risk and the loss of mobility, vitality and independence that can follow.

At the center of the new division is SENTRX™ purpose-built Balance & Stability footwear engineered from the ground up by SQAIRZ to help create a more stable foundation for everyday movement. In addition, SQAIRZ Medical has developed a holistic clinical framework designed to provide a critical continuum of support.

That framework integrates a Balance & Stability Protocol that connects objective fall-risk assessment, SQAIRZ’s biomechanically engineered footwear, individualized clinical intervention, and ongoing outcomes tracking into a single approach that optimizes support at every stage of the balance and stability journey.

The need is urgent. One in four U.S. adults over age 65 falls at least once every year. For adults over 80, the risk increases to one in two. Fall-related injuries account for more than $80 billion in annual U.S. healthcare spending, while also diminishing an individual’s ability to fully engage in the relationships and experiences that define quality of life.

“For more than a decade, SQAIRZ has studied the relationship between the ground, the foot, stability and human performance,” said Bob Winskowicz, Founder and CEO of SQAIRZ. “SQAIRZ Medical represents the next evolution of that work. We believe that better stability should not only help an athlete perform better. It can help people continue living better. Our goal is to identify risk earlier, provide meaningful intervention and help people maintain the movement, confidence and independence that make a full life possible.”

Beyond the Shoe: A Complete Solution

The SQAIRZ Medical approach begins with a simple premise: you cannot effectively address a risk you have not first measured.

Through the SQAIRZ Balance & Stability Program, healthcare providers can use Kinetisense® Risk of Fall and Gait Assessment technology to perform a rapid 3D movement assessment that evaluates walking speed, stride pattern, body sway, compensatory movement and an individual’s fall-risk percentage.

Those insights help inform an individualized stability plan. The SQAIRZ clinical pathway is designed around escalating levels of intervention based on identified risk, ranging from neuromuscular education and baseline guidance for lower-risk patients to appropriate orthopedic solutions.

That includes SENTRX, purpose-built balance and stability footwear engineered with a wider natural base of support, a toe box that allows the toes to spread naturally for better balance, and a high-traction outsole that helps maintain connection with the ground; and, where appropriate, Thrive Orthopedics lateral or anterior AFO bracing. Follow-up testing and outcomes tracking allow providers to reassess patients over time.

Integrates into Clinical Care

SQAIRZ Medical is being developed around the realities of clinical adoption, patient access and reimbursement.

For patients whose assessment indicates a greater need for stabilization, the SQAIRZ clinical pathway incorporates Thrive Orthopedics AFO solutions, including pathways identified in SQAIRZ materials under L1952 and L1933. The broader program is supported with provider education, treatment-pathway guidance, documentation tools, chart-note templates and letters of medical necessity.

SQAIRZ patient materials indicate that SENTRX footwear may be covered through Medicare, depending on patient qualification and coverage. Patients may also have HSA/FSA payment options.

The goal is to create a Balance & Stability solution that can live not only in consumer commerce, but inside real patient-provider workflows.

Built with Medical Expertise

The development of SQAIRZ Medical is supported by a multidisciplinary Medical Advisory Board spanning orthopedics, podiatry, physical therapy, biomechanics, sports medicine and movement science.

The advisory group includes physicians, surgeons, podiatrists, physical therapists, researchers and biomechanics experts with experience across leading medical institutions, professional sports and clinical practice. Their role extends beyond product endorsement, helping inform clinical protocols, research priorities, provider education and the continued development of evidence-based approaches to balance and stability.

“In podiatry and sports medicine, we see every day how much the relationship between the foot and the ground influences balance, confidence and movement,” said Dr. Paul Klutts, DPM, Director of Fellowship for Kentucky and Indiana Foot and Ankle. “What is compelling about SQAIRZ Medical is that it approaches stability as a system: measure risk, create a stronger foundation at the foot and connect that intervention to ongoing clinical care. SENTRX is designed to make that foundation part of everyday life.”

“Fall risk is not a single-variable problem, and it should not be addressed with a single-variable solution,” said Dr. Larry Benz, PT, DPT, OCS, MBA, MAPP, FAPTA, Founder and CEO of Confluent Health. “The opportunity with SQAIRZ Medical is to connect objective assessment, footwear, individualized intervention and outcomes tracking in a way that can fit within the continuum of care. That kind of integrated approach can help clinicians move from reacting to falls toward identifying and addressing risk earlier.”

From Performance Footwear to Performance throughout Life

SQAIRZ Medical represents a natural expansion of the company’s original mission.

SQAIRZ was founded on the belief that performance starts where you stand. Across golf, baseball, softball and pickleball, the company has focused on the relationship between the ground, the foot, stability and human movement. SQAIRZ Medical applies that same foundational thinking to a different stage of life.

“People don’t wake up wanting a stability shoe. They want to keep doing the things they love. They want another walk with their spouse, another vacation, another birthday, another afternoon with their grandchildren. They want to remain active, vital and independent for as long as possible,” Winskowicz said. “That is what we mean by SQAIRZ FOR LIFE. From helping an athlete perform to helping someone maintain their movement and independence as they age, we want SQAIRZ to be The Foundation of Human Movement throughout every stage of life.”

About SQAIRZ

SQAIRZ is a biomechanically driven performance footwear company founded on the principle that performance starts where you stand. Through footwear engineered to enhance stability, ground connection and movement, SQAIRZ serves athletes across golf, baseball, softball, pickleball and now consumers through SQAIRZ Medical. For more information, visit SQAIRZ.com or SQAIRZMedical.com.

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MHK and MCG Partner to Connect Evidence-Based Clinical Guidance with Standards-Based Prior Authorization

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New integration to help health plans streamline prior authorization and prepare for CMS-0057-F compliance

SEATTLE, Sept. 10, 2026 /PRNewswire/ — MCG Health, part of the Hearst Health network and the industry’s source of truth for trusted clinical guidance, announces a newly certified integration with MHK, a leading healthcare technology provider and a sibling Hearst Health company. The new integration connects the MCG Path interoperability solution directly with the MHK CareProminence prior authorization workflow, helping health plans streamline authorization processes while supporting standards-based interoperability required by the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F).

The prior authorization process has historically required healthcare providers and health plans to navigate separate clinical, documentation, and administrative requirements. When required clinical information is not clearly identified at the point of request, submissions may be incomplete, resulting in requests for additional information, manual follow-up, longer review cycles, and ultimately, delayed care for members. Simultaneously, health plans seek to balance adapting their current utilization management workflows to the evolution of standards-based interoperability.

The new MHK CareProminence and MCG Path integration brings highly trusted clinical guidance and documentation requirements directly into the authorization workflow, connecting capabilities that have traditionally operated as separate steps. Using HL7® Da Vinci Project burden reduction standards – including Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS) – the integration surfaces evidence-based MCG clinical indications and structured documentation requirements at the point of a prior authorization request.

The integration is designed to help health plans:

Support evidence-based decision-making by incorporating the nationally recognized MCG care guidelines into the prior authorization workflowReduce administrative burden by helping providers identify and submit required clinical documentation earlier in the processPromote more consistent reviews by making structured clinical requirements available within existing workflowsAdvance interoperability readiness by supporting HL7 Da Vinci standards associated with CMS-0057-F API requirements that are primarily due January 1, 2027

One of the first to utilize the MHK-MCG integration will be Mountain Pacific, a multi-state nonprofit organization with a long history of innovation and healthcare quality improvement.

“We’re excited to integrate MHK CareProminence and MCG into our medical necessity review process for prior authorization as part of our continued commitment to modernizing healthcare delivery,” said Jill Alessi, Chief Executive Officer at Mountain Pacific. “By connecting trusted, nationally recognized, evidence-based clinical guidelines with clearer documentation requirements, this integration has the potential to reduce administrative burden, streamline the review process, facilitate timely care, strengthen collaboration, and support a more efficient experience for providers and their patients.”

“Prior authorization works best when clinical guidance, documentation requirements, and the authorization workflow are connected rather than operating as separate steps,” said Carol Helton, COO of MHK. “Bringing MCG’s trusted clinical guidance directly into CareProminence enables health plans to simplify that process while giving providers clearer information at the point of request. Equally important, this integration gives our customers a practical path toward the standards-based interoperability required under CMS-0057-F.”

“We’re seeing tremendous momentum for MCG Path as health plans across the country prepare for the next era of interoperable prior authorization,” said Jon Shreve, President and CEO of MCG Health. “Our partnership with MHK is a critical part of that progress, bringing the trust of MCG directly into the workflows health plans already use. Together, we’re driving more confident decisions that help patients get the right care.”

The certified MHK-MCG interoperability integration is currently available to health plans, and demonstrations can be requested via the MHK and MCG websites at mhk.com/contact/schedule-a-demo/ or mcg.com/contact-us/schedule-a-demo/.

About MCG Health

MCG, part of the Hearst Health network, is the trusted source of truth for clinical guidance in the healthcare industry. MCG combines evidence-based guidelines and analytics with artificial intelligence to guide efficient and accurate clinical decisions. MCG solutions are licensed by a vast majority of health plans, thousands of hospitals, and many state and federal government agencies to drive quality health outcomes while controlling costs. For more information, visit mcg.com.

About MHK

MHK, formerly MedHOK, is a leading provider of healthcare SaaS solutions for health plans, pharmacy benefit managers, and provider-sponsored organizations. MHK’s platforms support utilization management, case management, population health, pharmacy management, enrollment, and compliance. Headquartered in Tampa, Fla., MHK partners with payers nationwide to optimize operations, improve outcomes, and deliver superior member experiences. For more information, visit mhk.com.

About Mountain Pacific

Established in 1973, Mountain Pacific has decades of experience collaborating with healthcare professionals, consumers and communities across multiple states to deliver innovative solutions. Through federal, state and commercial funding and partnerships, Mountain Pacific brings national public health priorities to the local level to achieve better health outcomes, lower costs, greater access to high-quality care and improved patient experiences. Learn more at mountainpacific.org.

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NuxGame Heads to SBC Summit Lisbon 2026 With Its Full Ecosystem and a Seat on the Compliance Stage

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LIMASSOL, Cyprus, Sept. 10, 2026 /PRNewswire/ — NuxGame, a B2B iGaming software provider, will take part in SBC Summit Lisbon 2026, held from Sept. 29 to Oct. 1 at the Feira Internacional de Lisboa. The team will be based at Stand A326 in Hall 1, the event’s Networking Lounge sponsored by NuxGame, where operators can sit down with senior staff from the product and commercial teams.

From Software Provider to Open Ecosystem

The timing suits where the business now stands. NuxGame began in 2018 as a software provider for operators launching their first projects, and today it runs an open ecosystem built around operator growth. Lisbon is one of the few occasions in the year when all of it can be seen in one place, by the people who would use it day to day.

What Operators Will See at Stand A326

Across the three days, the team will walk operators through the NuxGame Ecosystem in full:

An award-winning turnkey casino and sportsbook platform.

A game aggregator with 18,500+ titles from 140+ providers.

Sweepstakes-ready infrastructure.

A vetted network of partners covering CRM, payments, orchestration, and traffic.

That last part saves time. Instead of assessing vendors market by market, operators plug into partners already working in the regions they are entering, with the software underneath coming from a single provider. It is all backed by a service team whose client satisfaction has averaged 4.8 out of 5 over the past six months.

Denis Kosinsky on the Compliance Tech Stage

On Thursday, Oct. 1, NuxGame Chief Product Officer Denis Kosinsky will join the panel “Closing the Loopholes: How to Combat Bonus Abuse” on the Regulation & Compliance stage, part of the summit’s new Compliance Tech track. The session looks at how operators can recognize evolving patterns of bonus exploitation and keep promotional spend flowing to the players it was designed for.

“A bonus budget is one of the most powerful growth tools an operator has, and it works best when the money reaches genuine players. The instinct is to tighten the rules for everyone, but that’s like locking the whole building because one window doesn’t shut. Better to find the window. When you can see clearly how a promotion is actually being used, you close that one gap and leave the offer generous for everybody else.”

— Denis Kosinsky, Chief Product Officer at NuxGame

Book a Meeting in Lisbon

“Lisbon is where a lot of operators decide what their next year looks like. We wanted a space where those conversations can happen properly, with the platform, the content, and the partner network all in the room at once. Twenty minutes with the right people will tell you more than three months of comparing suppliers on paper.”

— Daniel Heywood, Chief Executive Officer at NuxGame

Operators, affiliates, and partners attending the summit can book a meeting with the NuxGame team in advance, or stop by Stand A326 in Hall 1 on any of the three days.

About NuxGame

NuxGame is a B2B iGaming company founded in 2018 that has grown from a software provider into an open ecosystem for operator growth. It combines an award-winning casino and sportsbook platform, a game aggregator with 18,500+ titles from 140+ providers, sweepstakes-ready infrastructure, and a vetted network of partners covering CRM, payments, orchestration, and traffic, supporting 100+ operators worldwide as they launch, scale, and enter new markets. In 2026, NuxGame was named Casino Platform of the Year at the iGaming News Awards. Visit https://nuxgame.com/ for more information and inquiries.

Media Contact: Yanina Kaplya, CMO at NuxGame, info@nuxgame.com

Original Source: https://nuxgame.com/blog/nuxgame-sbc-summit-lisbon-2026

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