Insurance Eligibility Verification Market Report 2026

The insurance eligibility verification market size has grown strongly in recent years. It will grow from $2.39 billion in 2025 to $2.57 billion in 2026 at a compound annual growth rate (CAGR) of 7.5%. The growth in the historic period can be attributed to rising healthcare billing complexity, increasing insurance claim denial rates, expansion of digital health records usage, growing need for revenue cycle optimization, increased administrative burden on providers.

The insurance eligibility verification market size is expected to see strong growth in the next few years. It will grow to $3.4 billion in 2030 at a compound annual growth rate (CAGR) of 7.2%. The growth in the forecast period can be attributed to growing adoption of AI-driven verification tools, rising focus on interoperability standards, expansion of telehealth services, increasing demand for real-time patient eligibility checks, growing investments in healthcare IT automation. Major trends in the forecast period include increasing adoption of automated eligibility verification platforms, rising use of real-time insurance data integration, growing deployment of cloud-based verification solutions, expansion of api-driven interoperability with payers, enhanced focus on error reduction and claim accuracy.

The increasing number of insured individuals is expected to drive the growth of the insurance eligibility verification market in the coming years. Insured individuals are people who hold coverage through an insurance policy, offering financial protection against specific risks or losses. The rise in the number of insured individuals is influenced by factors such as the expansion of government healthcare programs, growth in employer-sponsored insurance plans, and heightened awareness of the importance of health coverage. Insurance eligibility verification supports insured individuals by confirming accurate coverage information and preventing claim denials, unexpected expenses, and delays in treatment. This process improves transparency, lowers financial burden, and enhances the overall patient experience. For example, in September 2025, according to the United States Census Bureau, a US-based government agency, in 2024, the majority of people (92 percent or 310 million) had health insurance for part or all of the year. Therefore, the growing number of insured individuals is driving the expansion of the insurance eligibility verification market.

Companies in the insurance eligibility verification market are focusing on AI-powered advancements to enhance efficiency and accuracy in the verification process. One such innovation is AI-driven dental insurance verification, which integrates with dental practice management systems to automate eligibility checks, reduce administrative workload, and minimize errors. In June 2024, Pearl Inc., a US-based dental AI company, introduced Precheck, an AI-powered insurance eligibility verification tool. Utilizing natural language processing, Precheck streamlines the verification process, providing dental practices with precise and comprehensive coverage information. It can identify insurance coverage for 30% more patients compared to traditional verification methods, improving operational efficiency and strengthening patient trust in dental care.

In November 2023, Experian Health, a US-based healthcare technology company, acquired Wave HDC for an undisclosed amount. This acquisition is aimed at enhancing Experian Health’s patient access solutions by offering real-time, single-inquiry insurance discovery and verification at the point of patient registration. Wave HDC, a US-based healthcare technology provider, specializes in insurance verification services.

Major companies operating in the insurance eligibility verification market are Access Healthcare, Flatworld Solutions, Waystar, Firstsource, Medusind Solutions, SunTec India, Plutus Health Inc., AdvancedMD, Vee Healthtek, OmniMD, ClinicSpectrum, DataMatrix Technologies, Business Integrity Services, e-care India, Medical Billing Wholesalers, SSR Techvison Pvt, Clearwave Corporation, AccuReg Software, eClaimStatus, iTech Data Services, pVerify Inc., Cortex EDI Inc., AGS Health, Outsource Strategies International, Med Xpert Services.

Asia-Pacific was the largest region in the insurance eligibility verification market in 2025. The regions covered in the insurance eligibility verification market report are Asia-Pacific, South East Asia, Western Europe, Eastern Europe, North America, South America, Middle East, Africa. The countries covered in the insurance eligibility verification market report are Australia, Brazil, China, France, Germany, India, Indonesia, Japan, Taiwan, Russia, South Korea, UK, USA, Canada, Italy, Spain.

The insurance eligibility verification market includes revenues earned by entities by providing services such as coordination of benefits (COB) verification, claim denial prevention, data accuracy and documentation, and patient financial counseling support. The market value includes the value of related goods sold by the service provider or included within the service offering. Only goods and services traded between entities or sold to end consumers are included.

The market value is defined as the revenues that enterprises gain from the sale of goods and/or services within the specified market and geography through sales, grants, or donations in terms of the currency (in USD unless otherwise specified).

The revenues for a specified geography are consumption values that are revenues generated by organizations in the specified geography within the market, irrespective of where they are produced. It does not include revenues from resales along the supply chain, either further along the supply chain or as part of other products.

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