Payment Integrity Market Size, Share, Growth, Report 2026 To 2035

Payment Integrity Market Size and Growth 2026 to 2035

The global payment integrity market size reached at USD 8.26 billion in 2025 and is expected to be worth around USD 34.82 billion by 2035, exhibiting at a compound annual growth rate (CAGR) of 15.5% over the forecast period 2026 to 2035. The payment integrity market is growing as healthcare organizations and payers are more pressured than ever to decrease financial leakage and payment inaccuracies. With pressure on payers and providers to find fraud, waste and abuse in claims, there is an increased demand for advanced analytics and AI-based technology. This trend is also being advanced by value-based care models, as many organizations are determining how to guarantee payments are accurate, and compliant. Additionally, increasing complexity of healthcare billing and coding systems increases the need for technology that can identify errors prior to making payments.

Another major catalyst for the payment integrity market is the complexity of healthcare payments and changes in regulations. New healthcare codes, new policies, and value-based payment models will mean payers need better tools to ensure compliance and transparency. The payment integrity market continues to foster synergy in the marketplace through the adoption of cloud-based platforms and integrated payment integrity solutions. These integrated solutions simplify and accelerate payment integrity initiatives, allow for easier scalability, and eliminate the siloed approach. As healthcare systems globally continue to encourage accuracy and accountability, the payment integrity market will continue to grow due to technological innovation and demand for operational excellence.

Report Highlights

• By Region, North America leads the payment integrity market with a 41.5% share, driven by advanced healthcare systems, strong regulatory frameworks, and widespread adoption of AI-based payment validation tools.
• By Region, Asia-Pacific holds 22.4% share and is the fastest-growing region, fueled by rapid healthcare digitization, expanding insurance coverage, and government-led health reforms.
• By Solution Types, Fraud, Waste & Abuse (FWA) Detection dominates with 38.6% share due to its critical role in identifying fraudulent and improper claims.
• By Service Stage, post-payment segment holds the highest share at 51.6%, as payers continue to rely on retrospective audits to recover lost funds and identify billing errors.
• By End-user, private payers represent the largest end-user group with 44.3% share, driven by large claim volumes, higher operational budgets, and focus on automation for payment accuracy. 

What is Payment Integrity?

Payment integrity is the practice of validating the accuracy, authenticity, and proper services and payments that should be paid. It consists of identifying and preventing errors, fraud, waste, and abuse of claims, prior and after payment. Payment integrity programs rely on analytics, automation, and auditing to ensure payers are only paying the legitimate claims while increasing transparency and efficiency throughout the healthcare system.

The importance of payment integrity is:

• It establishes accurate and fair payment for healthcare
• It minimizes financial loss from fraud, waste, and abuse
• It promotes adherence to health care regulations
• It increases efficiency in payment processing
• It generates trust among payers, providers, and patients
• It enhances value-based care and resource utilization overall
• It improves the transparency and accountability of the data.

Increasing Application of Payment Integrity in Healthcare

Due to a desire to decrease claim errors and costs associated with unneeded care, the healthcare space is experiencing a larger uptake of payment integrity solutions. Hospitals, payers, and government funded health programs are now able to leverage payment integrity tools in order to validate that billing is correct, or that fraud, duplicate payments, and other claim errors has not occurred. The switch to electronic health records (EHR) and automated claims processing will provide many more opportunities to further apply advanced analytics, machine learning, and AI in support of payment integrity and validation. Such opportunities benefit the overall healthcare system through financial improvement, regulatory compliance, and paying healthcare providers the correct amount for services rendered, which will ultimately fuel the expansion of payment integrity solutions in the healthcare space overall.

The preceding graph delineates the upward trajectory of the costs (in USD billion) and use (%) of payment integrity solutions. Overall, the industry is exhibiting sustained and robust growth, with spending growing from USD 4.8 billion in 2020, to USD 16.2 billion in 2025. The orange line shows the commitment dynamic in the adoption, rising from an estimated 4.5%, to the 14.6% that presides on the cost line each year that goes by more and more healthcare organizations are adopting these solutions.

Market Trends

HealthEdge and UST HealthProof Merger

• The merger of HealthEdge with UST HealthProof formed a more robust AI-enabled platform that integrates claims processing, utilization management, and payment integrity solutions to support improvement in efficiency and accuracy for health care payers when managing claims. The end-to-end platform improves the payer experience by reducing the need for multiple vendors and simplifies payment operations. This collaboration advances growth in the payment integrity market by promoting a unified platform that strengthens accuracy, transparency, and speed of operations.

Lyric Acquisition of ClaimShark

• Lyric's acquisition of ClaimShark has significantly bolstered its payment integrity capabilities with Artificial Intelligence. Furthermore, it now offers advanced audit workflows and claim analysis tools. ClaimShark's tools, combined with Lyric solutions, will allow for broader and more complete claim management solutions for payers. This acquisition is consistent with the trend of increasing automation and AI in Intelligent Payment Integrity and reducing human errors. Ultimately, providing greater payment integrity solutions will demonstrate increased value in technology-focused, innovative partnerships.

HealthEdge and Codoxo Partnership Using GenAI

• The collaboration between HealthEdge and Codoxo has introduced generative AI into payment integrity systems and enabled a timelier intervention on claims and earlier detection of errors. This partnership enables payers to genuinely prevent fraud and save money on overpayments prior to claims being paid. Combining an AI-generated insight with real time claim processing, the HeyalthEdge-Codoxo collaboration illustrates how intelligent automation can increase accuracy and efficiency. This new initiative advances the payment integrity market to become even more proactive, generating AI based results that are ongoing, smarter and faster.

Integration of Gynisus AI Platform into HealthEdge Source™

• The incorporation of the Gynisus AI platform within HealthEdge Source™ enhances clinical accuracy to payment integrity efforts by automating complex claims decisions to ensure reimbursement consistency with clinical standards and policy rules. This capability drives improved accuracy and lessens the chance of human fatigue and error in claims economic performance. As continued to propagate automation and decision-making capabilities, this will improve the reliability, scalability, and accuracy of the payment integrity market when it is based on data emerging from healthcare payments.

Report Scope

Market Dynamics

Market Drivers

Growing Need to Reduce Healthcare Costs

• One of the main drivers of payment integrity market is the increasing pressure to manage rising healthcare costs and reduce waste. Healthcare payers process a high volume of complicated claims (or billing) which may lead to errors, overpayments or fraud. Payment integrity programs can help to mitigate these problems earlier in the pre-claims process to ensure the claims being processed are accurate and compliant. Increased interest in the efficiencies related to cost pressures is causing both government and private payers to utilize sophisticated analytics and automation and is fuelling market growth.

Adoption of Artificial Intelligence and Automation

• The growing integration of artificial intelligence (AI) and machine learning is another strong driver of the payment integrity market. Data related to AI and machine learning is able to be examined in real-time which means payers can identify anomalies in claims and identify potential fraud faster than manual processes. AI also enables predictive analytics to be used by organizations to help identify potential improper payments before it happens. The increased use of automation improves operational efficiencies, transparency and accuracy and is driving continued market growth.

Market Restraints

Data Privacy and Security Concerns

• Data privacy and security concerns are a key constraint to market growth in the payment integrity market. Payment integrity technologies require access to sensitive clinical and financial details of patients, which also enhances data breach risk and regulatory violations. Data privacy regulations such as HIPAA and GDPR create situations where payers and providers are unable or unwilling to share data. Not only are there enhanced privacy concerns, the strict data protection laws are limiting the adoption of a comprehensive payment integrity systems.

Lack of Standardization in Claims Processing

• The variability inherent in billing and claim submission processes in healthcare is also a significant limitation for market adoption in the payment integrity market. The differences in coding standards, claim formats, and auditing processes for claims vary from organization to organization, and sometimes state to state. The differences in billing standards or electronic data interchange create complexity in standardizing payment integrity technology which increases administrative costs and leads to inefficiency and inhibits the ability for wide-scale uptake of improved payment integrity systems.

Market Opportunities

Shift Toward Value-Based Care Models

• The world shift from fee-for-service (FFS) to value-based care (VBC) is creating new opportunities for Payment Integrity products within healthcare payment systems. VBC models pay providers based on quality outcomes rather than number of services provided, which are redefining the importance of having timely and accurate payments for utilization and overall satisfaction for providers. Tools that fall under the umbrella of payment integrity solutions will assess claims for payment to providers against patient outcomes. This transformation will give way to vendors developing more integrated platforms that blend financial and clinical data to enhance clarity in Payment Integrity.

Expansion of Digital Healthcare Infrastructure

• The digital transformation of the healthcare industry is a major growth opportunity for the Payment Integrity market, especially in the emerging markets throughout the world. The increased utilization of cloud computing, AI, and the Big Data analytical and models for healthcare is pushing organizations toward accurateness to modernize Payment Integrity systems and processes. Vendors who have scalable, secure, automated Payment Integrity solutions will also benefit from increased interest in the digital transformation and efficiencies.

Market Challenges

High Implementation and Integration Costs

• A significant hurdle for the payment integrity sector is the substantial cost associated with the adoption of advanced analytics and artificial intelligence solutions. Smaller healthcare organizations and payers typically do not have the budget or infrastructure to support these solutions. The majority of advanced analytics and artificial intelligence solutions require qualified personnel, software customization, and ongoing system and operational support which add to the overall costs, creating a barrier to adoption across the payment integrity sector, especially for small to medium sized providers.

Resistance to Technological Change

• Another significant challenge in the payment integrity space is resistance to change among healthcare stakeholders. Many still do manual claim review processes and have legacy systems. Transforming to automated, AI- based payment integrity solutions is a challenge, as everything has to change: workflows, staff training, and culture. Some payers and providers are not ready to transform their organization, which slows down digital transformation and limits the full potential for the market and organizations.

Regional Analysis

The payment integrity market is segmented into various regions, including North America, Europe, Asia-Pacific, and LAMEA. Here is a brief overview of each region:

North America Payment Integrity Market: Established Ecosystem with Large-Scale Adoption Driving Market

North America is shaped by a backdrop of advanced healthcare infrastructure, strict regulatory frameworks, and a high level of healthcare expenditure that necessitates strong solutions for payment accuracy. The impetus represented by preventing improper payments across significant public programmes and commercial insurers is driving the uptake of technologies, such as AI and analytics, to support payment integrity approaches to claim validation and fraud detection. The relative pressure is making payment integrity a strategic imperative among payers and providers across the North American region.

Recent Developments:

• An increase in the use of real-time payment integrity interventions for embedded workflow solutions for providers to mitigate downstream denials.
• Increased regulatory attention to reducing claim errors and overpayments in public health programmes.
• Key players acquiring specialized companies to grow payment integrity offerings (e.g., analytics, coding validation) in the United States.

Europe Payment Integrity Market: Regulatory Push and Infrastructure Upgrades Fuel Growth

The European market has been catalyzed by regulatory reform, increasing complexity of cross-border claims, and an increasing focus on value-based care implicating payment controls and data expertise. In the region, healthcare payers and governments are updating their systems to validate claims in real-time and mitigate fraud providing some momentum for payment integrity solutions through Europe. The new initiatives towards standardisation and pan-European reforms will further provide opportunities.

Recent Developments:

• The new EU instant payments regulation that requires banks to be updated for 24/7/365 instant payment acceptance and tighter fraud screening and monitoring requirements calling for a greater need for a payment-integrity framework.
• The launch of the Wero digital wallet features as part of European Payments Initiative is the latest iteration of work taking place around reforming payment infrastructure relevant to integrity to both claims and payments.

Asia-Pacific (APAC) Payment Integrity Market: Rapid Digitalisation and Emerging Healthcare Spending Spur Expansion

In the Asia-Pacific region is experiencing vigorous growth patterns as healthcare spending increases, insurance coverage expands, and technologies for digital health and payments are adopted. Along with increased awareness of fraud, waste, and abuse in claims, coupled with transitions from legacy systems to cloud-based platforms, payment integrity solutions can be positioned well in the market. Emerging markets in particular are catching up with existing markets, thereby increasing vendors' available addressable markets.

Recent Developments:

• According to recent market reports, the Asia-Pacific region is the fastest growing region for payment-integrity platforms due to healthy digital transformation in the region and increasing volumes of claims.
• Cloud-based deployments and improved analytics infrastructure are allowing healthcare organisations in APAC to deploy advanced payment integrity tools.

Payment Integrity Market Share, By Region, 2024 (%)

LAMEA Payment Integrity Market: High Growth Potential with Untapped Healthcare Payment Integrity Needs

The LAMEA is shaped by a growing desire to reduce inappropriate healthcare payments, the limited availability of legacy claims management infrastructures, and growing regulatory focus on fraud and abuse. Although the level of investment is lower compared to developed regions, the large population of underserved healthcare markets and increasing levels of digitalisation underpin investment opportunities for payment integrity solutions on-boarding third-party providers within health systems or ensuring the integrity of payments in emerging markets.

Recent Developments:

• Reports have noted that LAMEA regions are emerging market opportunities for medical payment integrity tools as healthcare systems modernise and regulatory oversight is enhanced.
• Shifting towards cloud-based platforms and creating improved mobile payment infrastructure in the Middle East and Africa provides a further opening for new payment integrity solutions.

Segmental Analysis

The payment integrity market is segmented into solution type, service stage, end-user, and region. 

Solution Type Analysis

Fraud, Waste & Abuse (FWA) Detection is the leading segment in the payment integrity market because it performs a critical process in finding improper claims and reducing a payer’s financial loss. Payers and governments are investing heavily in FWA Solutions as they are attempting to combat healthcare fraud and improve overall compliance. With false claims and billing errors on the rise, FWA Tools will become a necessary part of quality assessment, reimbursement accuracy and cost containment. Advanced analytics and AI-enhanced FWA tools are allowing payers to recognize potentially fraudulent activities quicker, as a result, continuing to solidify this segments leading position.

Payment Integrity Market Share, By Solution Type, 2024 (%)

The Claims Editing & Coding Validation segment is the fastest growing segment. Increased complexity in medical coding systems and a rise in claims denials has resulted in the use of automated Claims Editing and Validation solutions. These claim editing tools are being adopted by healthcare organizations as they utilize them to ensure data is accurate and compliant prior to submission. The integration of AI and automatic capabilities continues to support growth, as vendors have now combined payers and providers with the latest technology to streamline human involvement to locate and repair coding errors sooner, thereby lessening administrative costs.

Service Stage Analysis

The post-payment represents the leading segment of the payment integrity market, as the majority of healthcare payers continue to rely on retrospective claim audits for overpayment and errors. Post-payment generally allows an organization to audit any past claims and recover any funds that were paid in error. While this occurs after payment it continues to play a vital role in protecting financial integrity and identifying claims that are problems over and above the question of payment. The continued substantial market share across public and private simply indicates a strong willingness to accept post-service as a necessary segment of the payment integrity market.

Payment Integrity Market Share, By Service Stage, 2024 (%)

Pre-payment represents the fastest growing area of the payment integrity market. As automation accelerates and predictive analytics adds opportunity, healthcare organizations are evolving their focus from recovery to protection. Pre-payment systems are designed to identify errors or inconsistencies before payment is made, thereby avoiding costlier rework and capturing increased claim accuracy. The accelerative nature of this change can be amplified through use of artificial intelligence powered pre-payment claim validation real time.

End-user Analysis

Private payers are the leading end-user segment in the payment integrity market as they are focused on reducing the financial leakage of claims paid and accurate reimbursement. Private payers invest considerably in advanced analytics and automation to effectively manage claim volume. Competition among private payers also drives the implementation of broad payment integrity programs that address claim accuracy and operational performance.

Public and government agencies are the fastest-growing end-users of the payment integrity market. Governments are accelerating payment integrity awareness to address fraud and efficiency in the public health program's, including Medicare and Medicaid. Increased demand for open spending of healthcare and regulatory commission to monitor spending results in significant investments in enhanced claim review systems. As a result, public agencies are quickly expanding the use of payment integrity technology for accountability and expenditure control.    

Payment Integrity Market Top Companies

• Cotiviti
• SAS Institute
• Optum
• EXL Service
• Conduent
• ClarisHealth
• Alivia Analytics
• Zelis
• Gainwell Technologies
• HealthEdge
• Ceris
• Apixio
• NTT DATA
• Integrity Advantage
• LexisNexis Risk Solutions

Key Industry Leaders’ Perspectives on the Payment Integrity Market:

Tisha Holden – Market President, Optum

• According to Tisha Holden, the payment integrity market is heading toward “payment precision.” She explains health plans should do better at paying claims correctly on the first attempt, which she believes means that provider workflows need real-time analytics and AI built into them. Rather than identifying errors after payment the goal should be preventing errors and payment integrity being built into payment.

Matthew Hawley – Executive Vice President of Payment Integrity Operations, Cotiviti

• Matthew Hawley identifies the value in the payment integrity market goes beyond simple cost savings or cost control. He believes that true success is built from innovation, benchmarking, and strong consultative relationships and partnerships between payers and solution providers. Hawley states payment integrity programs should add value as strategic assets, giving payers better decision making, improving operational performance, and improving payer/provider collaboration instead of treating payment integrity programs as just a cost-control mechanism.

Emad Rizk, M.D. – President & CEO, Cotiviti

• The payment integrity market is evolving, according to Emad Rizk, M.D., as payers are looking for integrated pre-payment and post-payment solutions. Rizk explains that combining these functions reduces waste and improves accuracy across the life cycle of a claim. Rizk states this change is a larger shift from reactively auditing, to proactive prevention efforts that leverage technology, improve financial performance, and ensure compliance.

Market Segmentation

By Solution Type

• Fraud, Waste & Abuse (FWA) Detection
• Claims Editing & Coding Validation
• Coordination of Benefits (COB)
• Payment Accuracy / Under-payment Recovery
• Others

By Service Stage

• Pre-payment
• Post-payment
• Continuous/Concurrent

By End-user

• Private Payers
• Healthcare Provider
• Public/Government Agencies
• TPAs & PBMs

By Region

• North America
• APAC
• Europe
• LAMEA