FAQs

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    Background
  • Who is FAIR Health?

    FAIR Health is a national, independent, nonprofit corporation whose mission is to bring transparency to healthcare costs and health insurance information through comprehensive data products, consumer resources and the support of health services research. 

    FAIR Health uses our database of billions of billed medical and dental services to:
    •    Power an award-winning, free website (www.fairhealthconsumer.org) that enables consumers to estimate and plan their medical and dental expenditures. The website offers clear, unbiased educational articles and videos about the healthcare insurance reimbursement system, as well.  FAIR Health also offers our cost lookup tools and educational material about healthcare costs and insurance in Spanish at consumidor.fairhealth.org and as mobile versions through Apple’s iTunes store and, for Android devices, Google Play
    •    Create data products, custom analytics and interactive data dashboards that we license to businesses, government agencies, policy-makers, healthcare providers, researchers and others.  With our professional staff of experts in healthcare, statistics, technology and communications, FAIR Health strives to offer information to all stakeholders in the healthcare sector.
     
    FAIR Health qualifies as a tax-exempt, public charity under section 501(c)(3) of the Internal Revenue Code.
     

  • Why was FAIR Health formed?

    FAIR Health was founded in 2009 after then-New York State Attorney General Andrew Cuomo uncovered potential conflicts of interest in the methods that health insurers were using to determine reimbursements to patients who received care from providers outside their health plans’ networks. The Office of the Attorney General reached settlement agreements with health insurance companies that do business in New York State; those agreements focused on bringing fairness and transparency to the out-of-network reimbursement system. 

    FAIR Health was established as part of this settlement.  Our mandate was to create and maintain a new database of charge data for healthcare procedures, to offer consumers tools to make it easier for them to estimate out-of-network expenses and to make our data available for academic research.  

    While the investigation took place in New York, the settlement had national implications.  Since our inception, FAIR Health has established a national reputation for bringing cost transparency to the healthcare sector; FAIR Health data currently power a range of data tools that are used by healthcare stakeholders across the nation.
     

  • How was the FAIR Health claims database created?

    In January 2009, then-New York Attorney General Andrew Cuomo announced the settlement of an investigation into the method used by certain health insurers to determine reimbursements for patients who receive care from out-of-network providers.  The settlement agreement reached with 12 health insurers focused on bringing fairness and transparency to the out-of-network reimbursement system by creating a non-industry, independent repository of claims data that would be overseen by a nonprofit organization.  FAIR Health was formed to establish that database and oversee the ongoing contribution of claims data to it. The FAIR Health database currently includes claims data from over 60 payors nationwide and covers 2002 to the present.
     

  • What is the purpose of FAIR Health and how is it unique?

    FAIR Health is committed to promoting transparency in healthcare costs and health insurance information through comprehensive data products, custom analytics, interactive data visualizations and consumer resources.  As an independent, unbiased source of healthcare cost information, FAIR Health is the trusted data provider to a wide range of customers including but not limited to payors, healthcare professionals, government agencies, unions, consultants, pharmaceutical companies, employers, consumers and researchers.
     

  • Who advises the work of FAIR Health?

    To help ensure our full commitment to and the realization of our healthcare cost transparency mission, FAIR Health relies on the ongoing guidance of stakeholder groups that are represented on our multiple advisory bodies, which include: 

    •    Board of Directors
    •    Consumer Advisory Board
    •    Customer Advisory Group
    •    Dental Actuarial Group
    •    Dental Advisory Board
    •    Physician Advisory Group
    •    Scientific Advisory Board
     

  • Who does FAIR Health serve?

    FAIR Health serves a broad range of healthcare stakeholders, among them:

    •    Commercial audiences (e.g., payors, third-party administrators, pharmaceutical companies, medical equipment companies, litigation
          support advisors and benefit consultants)
    •    Healthcare consumers
    •    Government agencies
    •    Researchers and universities
    •    Healthcare professionals and facilities
    •    Employers
    •    Unions and collectively bargained groups
    •    Public and private health insurance exchanges
     

  • How are FAIR Health data used?

    Stakeholders use FAIR Health data in a great variety of ways.  Some examples include: 

    •    Out-of-network (UCR) fee schedule development
    •    Reference point for legislated consumer protections and state health programs
    •    In-network fee schedule development
    •    Workers’ compensation and auto liability program fee schedule development
    •    Claims adjudication
    •    Cost transparency tools
    •    Public and private exchange plan selection and management
    •    Employee and member education
    •    Reimbursement risk management
    •    Network design and provider recruitment and negotiations
    •    Provider fee schedule evaluation
    •    In-network and out-of-network cost comparisons
    •    Healthcare cost projections
    •    Market research
    •    Sales and inventory planning
    •    Litigation support
    •    Research and policy development
    •    All Payer Claims Database (APCD) and Centers for Medicare and Medicaid Services (CMS) Data Center development and maintenance
    •    Government fee schedule development

    Visit Data Solutions to learn how your organization can use FAIR Health data.
     

  • Do states or other government entities use FAIR Health data?

    FAIR Health’s origins have made us a natural ally for policy-makers seeking reliable, independent data on healthcare charges, utilization and related data analytic services.  Consequently, FAIR Health has considerable experience in serving the healthcare data needs of numerous states and other government entities, ranging from external data validation for an All Payer Claims Database (APCD) to supporting the creation of workers’ compensation and auto liability program fee schedules, as well as a variety of other state health programs.
     
    In addition, under a New York State consumer protection law enacted in 2014 addressing surprise bills, emergency care services, dispute resolution and other aspects of healthcare cost transparency, FAIR Health’s data has been officially singled out as an approved source of objective reference data for determining the “usual and customary cost” (UCC) of healthcare services statewide.
     

  • Is FAIR Health’s data cited for official consumer protections or out-of-network dispute resolution?

    Yes, under a New York State consumer protection law enacted in 2014 addressing surprise bills, emergency care services and dispute resolution, FAIR Health’s data has been officially singled out as the approved source of objective reference data for determining the “usual and customary cost” (UCC) of healthcare services statewide.
     

  • How do I stay up-to-date with FAIR Health news?

    To keep abreast of news about FAIR Health, you may subscribe to FAIR Health newsletters, follow us on Twitter and join us on FacebookLinkedInGoogle+ and YouTube
     

    Our Data
  • Where does FAIR Health obtain its claims data?

    FAIR Health obtains our data from more than 60 health plans, insurance carriers and third-party administrators (TPAs) who contribute claims data through the FAIR Health Data Contribution Program described below.
     

  • What is in the FAIR Health data repository?

    The FAIR Health data repository is made up of de-identified data from billions of privately billed claims for medical and dental services submitted by healthcare professionals to health insurers across the nation.  The database includes over 21 billion billed procedures, from 2002 to the present. The database grows continuously as new data are received each month; we receive approximately a billion new claims each year.  The data are submitted to FAIR Health by healthcare payors that collectively insure over 150 million individuals in the private (i.e., non-government sponsored) healthcare system.  In addition to the privately billed claims, FAIR Health’s repository contains approximately three billion claims received from CMS.
     

  • How do you protect the privacy of patients, providers and data contributors?

    FAIR Health places the highest priority on the security of our contributors’ data.  We apply rigorous protocols to de-identify all personally identifiable patient information, in accordance with the Health Insurance Portability and Accountability Act (HIPAA) “safe harbor” rule and other requirements.  We also exclude from our data products any personal information that could identify a specific patient, provider, plan or contributor.
     

  • Who maintains the data?

    FAIR Health owns and manages the database and works with advisors from the academic and research community to refine the statistical methodologies and algorithms that are employed to develop and enhance the value of our products.
     

  • Who helps FAIR Health analyze and organize the claims data that it collects?

    FAIR Health’s expert staff works with a team of research universities known as the Upstate Health Research Network (UHRN) to examine the data and recommend the statistical methods by which FAIR Health develops its data tools. This team includes some of the most respected experts in healthcare policy, medicine, economics and statistics from academic institutions across the country and is led by Syracuse University and Cornell University.
     

  • How are the data in the FAIR Health database validated?

    FAIR Health applies rigorous quality assurance processes to validate data before they are accepted by the FAIR Health Data Contribution Program and added to our repository.  Each data submission undergoes a series of thorough edit checks by in-house experts in statistics, mathematics and information technology to help prevent flawed data from being included.  Part of this process involves testing the data with statistical algorithms to ensure that invalid entries are eliminated.  For example, FAIR Health identifies and quarantines claims data with invalid dates of service and/or invalid ZIP Codes.  If data fail to pass the edit checks, FAIR Health will contact the data contributor to address the source of errors or concerns.
     

  • How does FAIR Health make its data available?

    FAIR Health makes its data available in a range of formats to a variety of stakeholder groups.  We offer standard data products, custom analytics, the FH Fee Estimator® for Healthcare Professionals, consumer engagement tools and datasets for academic research that are made available through its Research Support Program.  FAIR Health also offers a separate website for consumers at www.fairhealthconsumer.org (consumidor.fairhealth.org in Spanish.)  You can learn more by visiting the Data Solutions section.
     

  • How does FAIR Health handle outliers that may represent invalid charges?

    FAIR Health employs a proprietary extreme outlier methodology to detect and remove data entries that represent invalid charge data.
     

  • How does FAIR Health handle small cells/low frequency data?

    To address small cells (i.e., procedures performed at a very low frequency in a particular geographic area), FAIR Health employs Relative Value Methodology. Click here to learn more.
     

  • What geographic areas are reflected in the FAIR Health database?

    The FAIR Health database includes billed charges from all geographic areas in the United States and its territories, including all 50 states; Washington, DC; Puerto Rico and the US Virgin Islands.  FAIR Health’s repository does not include billed charges from outside the United States.
     

  • How frequently are data in the products refreshed?

    FAIR Health data products are updated at least twice yearly to reflect new data collected and included in the FAIR Health claims database.  Product modules include 12 months of data that are updated for each release.  The cutoff date for data to be included in a module is three months prior to the release date.
     

  • Does FAIR Health set “usual and customary rates” for insurers?

    No.  FAIR Health offers benchmark data to assist insurers in establishing usual and customary rates (UCR) for out-of-network reimbursement.  FAIR Health does not set UCR rates or out-of-network reimbursement amounts; those determinations are made by insurers themselves.  FAIR Health data are intended to inform those decisions.
     

    What We Offer
  • Standard and Custom Data Products
    • What data offerings are available?

      FAIR Health licenses a range of data offerings for organizations:
      •    Standard data products are available in two series: FH® Benchmarks and FH® RV (Relative Value) Benchmarks that include benchmark charge data organized by procedure and reported at the level of the geo-zip (typically a region identified by the first three digits of a ZIP Code).The FH Benchmark and RV Benchmark products include data for a rolling 12-month period ending three months prior to the release of the module. The FH RV Benchmark series contains derived data based on actual charges and relative values and the FH Benchmarks modules generally contain benchmarks based on actual data.  FAIR Health’s standard data product modules include:
           o    Medical/Surgical
           o    Dental
           o    Anesthesia
           o    Inpatient Facility
           o    Outpatient Facility
           o    Healthcare Common Procedure Coding System (HCPCS)
           o    Allowed Medical
           o    Ambulatory Surgery Center (ASC)

      •    Custom analytics and derivative cuts of data modules are also available and can be configured to customer specifications, including national, regional and local geographic cuts. See more below. 

      To learn more about FAIR Health data product offerings, visit the Standard Products section, or the Custom Analytics section. You may also contact FH Support by e-mail at service@fairhealth.org  or call 855-301-3247, Monday through Friday, 9:00 a.m. to 6:00 p.m. Eastern Time.
       
    • Does FAIR Health offer a product to help organizations that reimburse based on Medicare fees?

      Yes.  Our FH Medicare GapFill PLUS™ product offers an easy-to-use solution for organizations that employ Medicare fees as a basis for out-of-network reimbursement. It provides in a single file values for services included in the CMS Medicare Physician Fee Schedule, along with professional fees based on FAIR Health data for codes that are not valued.
       
    • What types of custom analytics are available?

      FAIR Health staff work with our clients to create custom cuts of data that meet their specific needs.  We also create interactive data dashboards and visualizations that illuminate findings.  Examples of customized analyses include:
      • Custom geographic areas—national, regional, state and local—and geo-zip combinations.
      • Custom groupings of procedure codes.
      • Analysis of service utilization patterns.
      • Data for specific time periods.

      To learn more, e-mail FH Support at service@fairhealth.org or call 855-301-3247, Monday through Friday, 9:00 a.m. to 6:00 p.m. Eastern Time. You may also visit the Custom Analytics section.
       
    • Can data for select procedure codes or geographic areas be licensed?

      Yes.  FAIR Health works with organizations to tailor and array data based on custom specifications.  Clients who are interested in this option can e-mail FH Support at service@fairhealth.org or call 855-301-3247, Monday through Friday, 9:00 a.m. to 6:00 p.m. Eastern Time.  You may also visit the Custom Analytics section.
       
    • What types of business decisions can be informed by custom analytic datasets?

      Custom datasets can support a range of uses, including:
      •    Forecasting 
      •    Strategic planning 
      •    Reference pricing 
      •    Network and benefit design
      •    Health economics research 
      •    Public policy development 
      •    Litigation support 
      •    Workers’ compensation and auto liability fee schedules
      •    Needs of public and private insurance exchanges 

      For more information, e-mail FH Support at service@fairhealth.org or call 855-301-3247, Monday through Friday, 9:00 a.m. to 6:00 p.m. Eastern Time.  You may also visit the Custom Analytics section.
       
    • How does FAIR Health validate its data products?

      FAIR Health has established a rigorous process to help ensure the integrity of the data in its database and products.  Data are carefully validated before being accepted through the FAIR Health Data Contribution Program.  Part of this process involves testing the data with statistical algorithms to ensure that invalid entries are eliminated.  Each release of FAIR Health products is examined by in-house experts in statistics, mathematics and information technology.
       
    • Can we integrate FAIR Health data into our benefits site?

      Yes, FAIR Health data can be licensed and integrated into benefits sites, for a licensing fee.  For more information, e-mail FH Support at service@fairhealth.org or call 855-301-3247, Monday through Friday, 9:00 a.m. to 6:00 p.m. Eastern Time.  You also may visit Consumer Engagement Tools.
       
    FH Fee Estimator®
    • Are data available for healthcare professionals?

      Yes.  FAIR Health offers a self-service online tool—FH Fee Estimator®—that allows doctors, dentists and practice managers to easily access benchmark data by geographic area to assist with a range of decision-making activities.  The tool offers access to cost data for dental procedures and over 30 medical specialties, and features flexible, low-cost licensing options.
       
    • How do healthcare professionals use the data from the FH Fee Estimator?

      Medical and dental healthcare professionals use the data from the FH Fee Estimator when evaluating fee schedules, weighing network opportunities, exploring practice expansion, assessing ACO participation, discussing billing with patients, evaluating revenue opportunities when leasing or purchasing equipment and for other purposes.
       
    Consumer Engagement Tools
    • Are FAIR Health data available to consumers?

      Yes.  FAIR Health maintains a free website, www.fairhealthconsumer.org, where consumers can obtain cost estimates based on actual charge data for services rendered in their geographic area by using the medical and dental cost lookup tools on the site.  FAIR Health also offers a companion mobile app for iPhones and Android devices, as well as a Spanish-language version of the consumer website.  Organizations can license privately labeled customized versions of these tools that they can “private label” with their own branding and messaging. Alternatively, organizations can license “hyperlinks” to the FAIR Health consumer platform.  Learn more about these licensing opportunities by visiting the Consumer Engagement Tools section.
       
    • What types of consumer engagement tools are available for license?

      FAIR Health offers special access to its consumer website in English and Spanish, as well as its English-language mobile app that is available on iPhone and Android devices.  In addition, FAIR Health licenses “private-label” versions of its consumer website, as well as sponsored links to these consumer-facing platforms.  Finally, FAIR Health makes its data available through an Application Programming Interface (API) that facilitates the integration of FAIR Health cost data into organizations’ existing enrollment tools and plan member portals.  To learn more about integrating FAIR Health data into your organization’s consumer-facing tools, contact FH Support by e-mail at service@fairhealth.org or call 855-301-3247, Monday through Friday, 9:00 a.m. to 6:00 p.m. Eastern Time. 
       
    • Does FAIR Health work with other organizations to develop educational content for employees, patients, and members?

      Yes, FAIR Health works with groups, including health plans, unions, employers and brokers, to develop educational resources and treatment cost calculators for their consumer constituents.  FAIR Health also makes its award-winning educational web content available by license to interested organizations. 

      To learn more, contact FH Support by e-mail at service@fairhealth.org or call 855-301-3247, Monday through Friday, 9:00 a.m. to 6:00 p.m. Eastern Time. You may also visit Consumer Engagement Tools.
       
    FH NPIC® Data for Research
    • Where can I learn more about licensing data sets for research?

      To learn more about licensing data sets from the FAIR Health National Private Insurance Claims (FH NPIC®) Database for research, please visit Research Support or see the Research Support FAQs.
       
    Contributing Data
  • What is the FAIR Health Data Contribution Program?

    Our clients rely on the FAIR Health database to provide a rich array of geographically specific benchmark data. The claims data that FAIR Health receives are contributed by payors through the FAIR Health Data Contribution Program.  Contributors receive credits against their license fees for FAIR Health data products as well as other incentives.  In addition, by contributing their data, these organizations ensure that their claims experience is represented in the tools that FAIR Health offers the industry.  A large data pool makes FAIR Health data products truly representative of the private insurance market and enables FAIR Health to develop new data products to serve the healthcare industry and its many stakeholders.
     

  • Who can submit data?

    For the reasons stated below, participation in the FAIR Health data contribution program is limited to the following types of organizations, provided that they are current licensees of FAIR Health data products:
    •    Health plans
    •    Insurance carriers
    •    Third-party administrators

    FAIR Health regrets that it cannot accept claims submissions from healthcare practitioners, due to the high probability that provider claims will not be unique and will result in the duplication of data within the database.
     
    To learn more about the value of participating in our data contribution program, contact FH Support by e-mail at service@fairhealth.org or call 855-301-3247, Monday through Friday, 9:00 a.m. to 6:00 p.m. Eastern Time. You also may visit the  Become a Contributor  section.
     

  • How do I submit data files to FAIR Health?

    After you sign up as a contributor, the FAIR Health data team will work closely with you to establish and test the file transfer protocols in order to get your organization’s data contribution up and running quickly and easily according to contribution guidelines.  We also will monitor your contribution feeds and provide guidance as needed.  For more information, visit How to Submit Data.
     

  • What incentives are there for submitting data to FAIR Health?

    FAIR Health offers credits that reduce data licensing fees to qualified data contributors.  Data credits will offset licensing fees for the next renewal term after the data are accepted by FAIR Health. 
     
    Participants in the data contribution program can earn credits of up to 50 percent of licensing fees for each product renewal term beginning after the data are accepted into the program.  Credits are based on the number of accepted claims and vary depending on the type of data provided.  Data contributors are also eligible to choose from certain complimentary data reports that offer valuable market insights. To learn more, contact FH Support by e-mail at service@fairhealth.org or call 855-301-3247, Monday through Friday, 9:00 a.m. to 6:00 p.m. Eastern Time.
     

  • Does FAIR Health provide training for contributing data?

    Yes, FAIR Health provides all contributors with telephone-based training for the initial set-up and ongoing data submission process.
     

    FAIR Health Support
  • What assistance does FAIR Health offer to clients?

    FAIR Health offers varying levels of assistance to clients, including answers to questions about our data and methodologies, training sessions and webinars via conference call, and specialized support which includes on-site training and hands-on assistance with a variety of service, product and client education topics.
     
    FAIR Health clients may contact the FH Support team by e-mail at service@fairhealth.org  or by calling 855-301-3247, Monday through Friday, 9:00 a.m. to 6:00 p.m. Eastern Time.