FAIR Health

Healthcare Data for a New Generation


Recognized across the national healthcare landscape for independence and neutrality and the reliability of our data, FAIR Health makes the nation's most comprehensive healthcare claims database available to help stakeholders understand the changing healthcare market. In addition to offering consumer engagement tools, FAIR Health licenses data products to businesses, government agencies, insurers, healthcare providers, academic researchers and others—serving as the foundation for strategic business decisions, daily business operations, research, policy and reform.


We offer claims and utilization data innovatively packaged to provide the information you need, when you need it, in the format that works most efficiently and effectively for you.



Contact us to learn more about how FAIR Health data solutions can help you meet your needs.







Equip Yourself with the Right Data


The FAIR Health product suite of standard modulescustom analytics and tools and delivery methods, including comparative dashboards and private-labeled websites, expands the ways in which organizations are using our claims data:


  • Fee schedule development;

    Health plans and third party administrators use the data to inform the development of usual, customary and reasonable schedules for out-of-network reimbursement as well as to develop in-network fee schedules and fee negotiation strategies.

  • Filling in gaps in Medicare fees;

    Health insurers that base reimbursement on Medicare fees turn to FAIR Health Medicare GapFill PLUS™. This product includes the Medicare fee schedule for codes valued by CMS, and seamlessly fills in the gaps with FAIR Health data, all in a single, uniform dataset.

  • Claims processing;

    Bill review companies use the data to help evaluate and process claims.

  • Employee and member customer service and education;

    Employers use the data to educate employees about health insurance principles, healthcare costs and how to manage their high-deductible health plans.

  • Reimbursement risk management;

    Self-insured employers and insurance carriers use the data to manage reimbursement risk under a variety of models (e.g., ACO, bundled payments, episodes of care, medical homes, etc.).

  • Network provider negotiations;

    Networks use the data to support their negotiations with providers.

  • Provider fee schedule evaluation;

    Healthcare professionals and healthcare systems use the data to evaluate in-network and out-of-network fee schedules, compensation arrangements and ACO participation.

  • In-network and out-of-network cost comparisons;

    Insurance carriers, TPAs and employers integrate benchmarks into portals that enable members to compare their plan-specific in-network fees to estimated out-of-network costs.

  • Healthcare cost projections;

    Unions and associations use the data to educate their members, and advocate on their behalf, about out-of-pocket healthcare costs.

  • Sales and inventory planning;

    Consultants use the data to advise healthcare and pharmaceutical clients about demand planning and inventory management.

  • Research and policy development;

    Academics and policymakers use the data to inform health services research and evaluate the impact of statutes and regulations.

  • All Payer Claims Database and CMS Data Center development;

    Government agencies use the data for the private claim component of all payer claims databases (APCDs) and to evaluate the integrity of APCD representativeness.

  • Government fee schedules; and

    States use the data to design workers’ compensation, auto liability and emergency care fee schedules and other state health programs.

  • New York State Budget Bill Compliance.

    New York-based insurers, providers and others turn to www.fairhealthny.org. to assess potential impacts of the New York State Budget Bill’s out-of-network reimbursement provisions. FAIR Health, recognized by New York as the only official source for healthcare cost data, offers online resources to help stakeholders fulfill disclosure, plan design and dispute resolution requirements under the New York Law.


Responsive Support


Our client services team is ready to help you take full advantage of your FAIR Health data products.

Your Best Decisions Start with FAIR Health Data


Our renowned medical and dental healthcare claims data are current, reliable, neutral, comprehensive and versatile. FAIR Health meets the needs of all stakeholders across the healthcare sector by offering::


  • Informative, transparent data products;

    The transparency and utility of our data and the products they comprise are assured by the diversity of our conflict-free governing body, expertise of our staff and oversight of nationally recognized healthcare industry advisors and academic leaders.

  • Largest private claims repository nationwide;

    Our database includes over 21 billion privately billed medical and dental services, submitted by contributors on behalf of plans covering over 150 million insured members. Our repository also includes approximately 4.5 billion claims received from CMS.

  • National data plus geographic specificity;

    Our data are available for up to 493 geographic regions in all 50 states, the District of Columbia, Puerto Rico and the Virgin Islands.

  • Historical and up-to-date;

    We offer data from 2002 to the present, continuously updated and expanded.

  • Methodologies shaped by expert guidance;

    Our data undergo robust auditing and validation processes that employ aggregation methodologies developed by independent experts in healthcare economics and statistics. Click here to learn more.‚Äč

  • Complete sample of submitted data;

    Our data are based on 100 percent of each participating payor’s claims for the submission period.

  • De-identified data; and

    All patient and other identifying information has been removed or otherwise encrypted from the claims in our database.

  • Powerful resource for planning and decision-making.

    The robust nature of our data and the availability of claims dating back to 2002 make the database a powerful tool for tracking healthcare trends over time and informing decisions related to benefit design, pricing, marketing and much more.


Contact us to learn more about how FAIR Health data solutions can help you meet your needs.

How to Access FAIR Health Data


Our data are available in a variety of formats to meet the needs of diverse stakeholders:


Commercial clients, researchers and government officials

  • File transfers in flexible formats to facilitate use in claims systems

    We fulfill requests for standard data modules in the format that best meets user needs and technological capabilities.

  • FH Online

    Access benchmark data with an easy-to-use online interface.

  • Custom datasets

    We create special cuts of cost and utilization data customized to meet user needs.

  • Visualizations and dashboards

    Interactive dashboards and analytics can clarify analyses and highlight findings.

  • Application Programming Interface (API) tools

    API technology can be used to display our data on organization websites and portals.

  • Record level data

    We pull data based on client specifications which can be delivered in comma-separated values (CSV) formats to facilitate working with large data sets.



  • Consumer website

    Available in English and Spanish, our award-winning consumer website offers individuals free access to medical and dental cost lookup tools and educational resources.

  • Mobile_apps

    The same information available through the consumer site can be accessed through our English / Spanish mobile apps for  iOS and  Android devices.

  • Private-label sites

    Health plans and other organizations can license a private-label version of the consumer website for employee or member use.

  • Client customer service portals

    The consumer website is licensed by a number of clients as a resource for their customer service teams responding to member or employee questions.


Visit our Info & Resources Library to learn more about FAIR Health data methodologies.

Responsive Support


Our client services team is ready to help you take full advantage of your FAIR Health data products.

The Industry Standard for Data Products


We organize our vast repository of healthcare charge and utilization data into the following modules:


  • Medical/Surgical;

    Medical/Surgical module – Benchmarks based on CPT codes for evaluation and management (E&M), medical, surgical, radiology, laboratory and pathology procedures.

  • Allowed Medical;

    Allowed Medical module – Benchmarks based on the in-network negotiated rates for procedures rather than fees charged by providers. Benchmarks are available for CPT codes including evaluation and management (E&M), medical, surgical, radiology and laboratory procedures.

  • Dental

    Dental module – Benchmarks based on CDT codes for approximately 600 distinct dental procedures.

  • Inpatient Facility;

    Inpatient Facility module – Benchmarks for services performed in a hospital inpatient setting, based on the Centers for Medicare & Medicaid Services (CMS) MEDPAR data. Benchmarks for services billed and payable by Diagnosis-Related Groups (DRGs) are provided as both a total DRG charge and per diem per DRG, taking into account the length of stay associated with the admission.

  • Outpatient Facility;

    Outpatient Facility module – Benchmarks for services performed in a hospital outpatient setting, based on the CMS Outpatient Standard Analytical File (OPSAF) data. Professional fees are available in the companion FH Medical/Surgical Benchmarks module.

  • Anesthesia;

    Anesthesia module – Benchmarks for anesthesia and CPT category I surgical procedure codes.

  • Healthcare Common Procedure Coding System (HCPCS);

    Healthcare Common Procedure Coding System (HCPCS) module – Benchmarks for Level II HCPCS codes covering products, supplies and services not included in CPT codes, such as ambulance services, durable medical equipment, prosthetics, orthotics and supplies when used outside a physician’s office.

  • Ambulatory Surgery Center(ASC); and

    Ambulatory Surgery Center module – Facility benchmarks for over 3,000 codes for procedures performed in an ASC. Professional fees are available in the companion FH Medical/Surgical Benchmarks module.

  • Medicare GapFill Plus.

    Medicare GapFill Plus Module – Includes the Medicare fee schedule for codes valued by CMS, and seamlessly fills the gaps with FAIR Health data, all in a single, uniform dataset.


Download our
Product Release Schedule here.


Your organization also might benefit from custom analyses of our data that meet your specific business needs.


Contact us to learn more about FAIR Health data solutions can help you meet your needs.


Responsive Support


Our client services team is ready to help you take full advantage of your FAIR Health data products.


Datasets Tailored to Your Specific Needs


In addition to our suite of standard benchmark data modules, FAIR Health will drill down into our claims data to create customized datasets that meet your business or research needs—offering cost and utilization data based on:


  • Provider specialty;
  • Geographic location;
  • Place of service settings;
  • Clinical specialities;
  • Trending over time;
  • Patient age and gender; and
  • Procedure, diagnosis code and category.


Dashboards That Illuminate Your Analyses


When you license a FAIR Health custom dataset, consider packaging it with turnkey visualization capabilities. Accessible on your desktop, FH DashboardsTM clarify your analyses with easy-to-use, interactive analytics.

Together, our custom data and dashboards support strategic planning and market research by revealing new insights, isolating data elements and highlighting your findings.



Make Our Data Your Data


You also can add FAIR Health benchmark data to your organization’s forecasting tools and member portals.  FAIR Health offers Application Programming Interface (API) technology to facilitate the display of data on your internal dashboards and portals, as well as treatment cost calculators for plan members.



Seeing Is Believing


Contact us to learn more about FH Customs or to request a demo of our FH Dashboards.


Responsive Support


Our client services team is ready to help you take full advantage of your FAIR Health data products.

Inform Your Planning with FH Episodes of Care Analytics


Understanding and managing the range of services and associated costs related to a complete treatment protocol (episode of care) presents opportunities for savings, quality improvement and the reduction of often costly potentially avoidable complications (PACs). In addition, it can help prepare an organization for the transition from fee-for-service to value-based reimbursement.

As the only independent nonprofit certified and licensed by the Health Care Incentives Improvement Institute (HCI3)  to operate its Prometheus Payment model®, FAIR Health and our FH Episodes of Care Analytics can help your organization manage risk and better plan for healthcare costs.


The Value of Risk-Based Patient Profiles


To take full advantage of claims data bundled as episodes of care, it is essential that organizations be able to view those data through the lens of real-life patient care scenarios that present combinations of factors that can affect those costs. FH Episodes of Care Analytics makes claims data truly actionable by allowing their analysis based on a wide range of risk-adjusted patient profiles and comorbidities.


Insights from Your Organization’s Data


FAIR Health will examine three years of your organization’s claims data to identify and isolate episodes and compare actual and expected costs based on risk-adjusted patient profiles. Our reports and analyses will help you:


  • Predict costs based on patients' conditions and risk profiles;
  • Develop detailed budgets;
  • Review provider performance in relation to expected outcomes;
  • Identify and share provider best practices;
  • Identify occurrences of and costs associated with PACs; and
  • Design effective educational campaigns for members.


Click here for additional information about FH Episodes of Care Analytics.


Learn more about how FH Episodes of Care Analytics can meet your organization’s needs by calling us toll-free at 1-855-301- 3247, Monday through Friday, 9 am to 6 pm ET.


Responsive Support


Our client services team is ready to help you take full advantage of your FAIR Health data products.

Easy, Immediate Access to Trusted Data for Healthcare Professionals


Setting the industry standard for fast, easy access to market-level charge information, FH Fee Estimator extends healthcare cost transparency to healthcare professionals. Doctors, dentists and practice managers can access data by geographic area for dentistry and medical specialties to assist with evaluating or developing fee schedules, planning practice expansion or technology acquisition, weighing network opportunities, assessing ACO participation, discussing billing with patients and more. Features include:

  • Immediate access to data for dentistry and over 30 medical specialties;
  • Online and downloadable formats; and
  • Flexible, low-cost licensing options.


Contact us to learn more about how FAIR Health data solutions can help you meet your needs.


Responsive Support


Our client services team is ready to help you take full advantage of your FAIR Health data products.