FAIR Health

A Unique Program to Support Healthcare Research

 

A key component of FAIR Health’s mission is to support the research that informs the way healthcare is planned, delivered and reimbursed. An independent, nonprofit organization known for the transparency and reliability of our medical and dental claims data, FAIR Health is ideally qualified as a research data resource.

 

For the purposes of our research support program, we define “research” as “a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge through the dissemination of findings via publication and/or scientific conferences.”

 

Researchers and policymakers across the country studying patterns, trends and geographic disparities in service utilization and private healthcare spending have utilized datasets we assemble from the nation’s largest, most trusted collection of private medical and dental claims data: The FAIR Health National Private Insurance Claims (NPIC) ®  database.

 

Our multi-faceted research support program offers the data and advanced informatics that can create the dataset you want, in the format you need. For those who need additional assistance, user support is available to help guide your use of the data to achieve your research goals.

 

Find out how to apply to license FAIR Health data for research purposes.

 

If you have a question about using our data for research, please visit the RESEARCH FAQs  page, or contact FAIR Health by e-mail at service@fairhealth.org  or by phone at 1-855-301-FAIR (3247), from 9 am to 6 pm ET, Monday through Friday.

 

Watch a video about the FAIR Health National Private Insurance Claims Database

Data Uniquely Suited for Research Purposes

 

Meeting the highest standards for quality, geographical representation and scope, FAIR Health’s data are uniquely suited to support health services research. We offer two forms of data products designed with researchers’ needs in mind:

 

·         FH Benchmark Modules. These benchmark products offer aggregated charge data based on 12 months of claims for medical, dental, anesthesia and HCPCS procedures, and more. Charges are arrayed by percentile for 493 distinct geographic regions nationwide. The mean, median and mode charges are also provided for each procedure in each region.

 

·         FH National Private Insurance Claims (NPIC) Standard Analytic Files (SAFs). ). These files contain underlying claims data for medical, dental, anesthesia and HCPCS procedures from the FH NPIC® database. They provide a range of elements, including procedure code, service ZIP Code, date of service, non-discounted fee billed by the provider, and more. We also offer historical data dating back to 2002.

 

The following attributes distinguish and qualify FAIR Health data as an essential resource:

 

  • Reliable sources

    FAIR Health receives data from approximately 60 private payers, including health plans, insurance carriers and Third Party Administrators.

  • Scope of services

    Submitted claims cover the spectrum of healthcare services, including medical/surgical, dental, Ambulatory Surgery Center (ASC), inpatient, outpatient, HCPCS, dental, anesthesia procedures and allowed charges.

  • Rigorous validation

    Upon receipt, all data are subject to a rigorous validation process to ensure they meet the standards for inclusion.

  • Data completeness

    All contributors submit all data from every state in which they are active. Their submitted data represent each contributor's full set of claims for the submission period.

  • Current and historic data

    Contributors submit data on an ongoing, rolling basis. Our databases also include historic claims data back to 2002.

 

Pricing to Meet Your Research Budget. 

The fees for licensing FH NPIC data are based on a number of variables:

 

Quantity of data:
  • Modules:
    • Number of complete product modules required
    • Number of years requested
  • Underlying claims data:
    • Number of procedure codes required
    • Scope of geographic coverage (national, regional, state(s), ZIP Code(s), geozip(s))
    • Number of years requested
Type of user:
  • Student
  • Researcher (individual or group) working on specific research project
  • Institution (site license for specified time period)

 

Bring Your Research to Light with Data Analytic Tools 

Visit the FH CUSTOMSTM  page to learn how our FH DashboardsTM, combined with custom FAIR Health datasets, can highlight the results of your research.

 

 

Find out how to apply to license FAIR Health data for research purposes. 

 

 

Research Support for the Classroom

 

FAIR Health data can be used by colleges and universities nationwide to advance research and to support curriculum development in a wide range of disciplines, including public health, public policy, bioinformatics, public health administration, healthcare economics, statistics, data science, health-related information technology, health law and related fields.

 

Schools can explore licensing data from our FH NPIC database by following the process described in the HOW TO APPLY  section, or take advantage of our Student Starter Kit for an introduction to the value of FAIR Health data. Available both to instructors for classroom use and to individual student researchers, the affordable Student Starter Kits help students learn to work with large, complex datasets, offering hands-on experience and insight into healthcare utilization and spending that can inspire ideas for future research.

 

Created from our FH NPIC database, the kits can be organized by clinical specialty, including cardiology, pulmonary disease, pediatrics, general surgery, gastroenterology, orthopedic surgery and dentistry. Faculty and students can choose to receive the data in either the aggregated healthcare data or record-level claims data   formats. Visit Student Starter Kit for more information.

 

 

RESEARCH FAQS

The following frequently asked questions address common inquiries about the FAIR Health National Private Insurance Claims (NPIC)® database and the FAIR Health research support program. If you have a related question that is not answered here, please contact FAIR Health by e-mail at service@fairhealth.org or call us at 1-855-301-FAIR (3247), from 9 am to 6 pm ET, Monday through Friday.



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    About the FH NPIC® Database
  • What types of datasets can researchers license from the FH NPIC Database?

    Two dataset categories are available for license: the FH NPIC Standard Analytic Files (FH NPIC SAFs), which consist of tailored, claims-level data extracted from our NPIC database as standard analytic files, and the FH® Benchmarks modules, a suite of aggregated datasets that are organized by service type.  See below for more information. 
  • What is the geographic distribution of the FH NPIC Database?

    FAIR Health receives contributed data from all 50 states, the District of Columbia, Puerto Rico and the Virgin Islands. 
  • Is a list of data contributors available?

    FAIR Health does not disclose the identities of its data contributors without their consent.
  • Is patient level data included in the FH NPIC Database?

    The FH NPIC database provides some information that pertains to each patient, such as gender and year of birth.  Depending on the nature and purpose of the research, and the data security provided by the research institution, FAIR Health may be able to include data that  constitute a Limited Data Set under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  For more information, contact FAIR Health to request a data dictionary.
  • What information is available in the underlying contributed data?

    FAIR Health receives up to 49 fields of information with respect to each claim.  Some fields are required; others, optional.  The required fields include the procedure code, the ZIP Code for the location where the procedure was performed, the date of service, the non-discounted fee for service billed by the provider, modifiers (if any) and units (if any).  Optional fields include the claim ID, claim type, information about providers and non-identifying information about patients, diagnostic codes, and more.  Certain patient identifiers are included in the data that contributors submit to FAIR Health.
  • Does the FH NPIC Database include pharmacy claims?

    Only provider-administered pharmaceutical claims are currently included. Those claims are provided in the FH HCPCS Benchmarks module.
  • Do the data provide plan type or insurance benefit design?

    “Plan Type” is an optional field which lists whether the claim is related to a PPO or HMO plan, workers’ compensation program, etc.  The data do not include copays, deductibles or other benefit design features.
  • How representative is the FH NPIC Database of the commercially insured population nationally?

    The health plans and other payors participating in the FAIR Health data contribution program report that they cover more than 150 million lives collectively.  Based on this, it is estimated that the data represent approximately 75 percent of the privately insured population.  This estimate is based on U.S. census data which list the total number of privately insured individuals at 201.1 million.
  • What types of research can the FH NPIC data support?

    Health insurance claims data provide information relevant to a variety of disciplines, ranging from epidemiology to healthcare economics.  Researchers can use the claims data in many ways, including, but not limited to:
    • Understanding geographic variations in frequency of use of healthcare procedures or products;
    • Comparing prices of two or more healthcare procedures or products;
    • Assessing how prices for specific services or procedures vary by specific factors, including geographic area, market concentration and other economic factors and provider density;
    • Comparing in and out-of-network reimbursement rates;
    • Analyzing the price and utilization of healthcare products or services;
    • Identifying disparities in healthcare service utilization; and
    • Evaluating the impact of regulations and legislation on healthcare utilization, cost, preventative care and treatment protocols.
    To address more complex research questions, investigators may combine FAIR Health data with data from other sources.  For example, information from other sources could be merged with FAIR Health data about providers to understand:
     
    • Whether physician behavior impacts reimbursement rates;
    • Whether quality of care impacts reimbursement rates for healthcare procedures; and
    • Whether outcomes are impacted by the utilization of certain diagnostic and preventative procedures.
    Researchers may also employ methodologies to help detect patterns of fraud and utilize propensity score matching to compare groups that receive different types of treatments.
  • When were the FH NPIC data collected?

    FAIR Health receives claims data from its data contributors continuously throughout the year. Typically, contributors submit data twice annually.  Some large contributors submit data monthly.  This combination of monthly and semi-annual data collection provides FAIR Health with a rich, varied and continuously refreshed pool of data.  The earliest records in the FH NPIC database date from 2002.
  • FAIR Health came into existence in 2009. How does it have data since 2002?

    FAIR Health acquired ownership of data for the 2002-2009 period from Ingenix, Inc. on December 31, 2010.  FAIR Health has received new data directly from our contributors since 2011.
  • How many contributors are reflected in the FH NPIC data?

    FAIR Health has more than 60 data contributors, including health plans, commercial insurers and TPAs, from all 50 states, the District of Columbia, Puerto Rico and the Virgin Islands.
  • What is the size of the FH NPIC Database?

    The FAIR Health data repository includes over 19 billion billed procedures spanning the period from 2002 to the present.  For the most recent 12-month period, the claims include data on over 150 million covered lives in the aggregate.
  • Has the content of the FH NPIC Database remained constant over time?

    FAIR Health receives data from commercial payors on an ongoing basis throughout the year. Consequently, the FH NPIC database continually expands to include the most recent claims data contributed.
  • How does FAIR Health determine that the information included in the FH NPIC Database is accurate?

    FAIR Health undertakes extensive measures to establish the accuracy of the data.  All of our data contributors must attest in writing that data submitted to FAIR Health includes 100 percent of the claims received by them during the defined time period and that the billed charge amounts represent the non-discounted fee-for-service charges billed by the provider.  Upon receipt, all data are subjected to a rigorous validation process to maintain consistent quality.  For example, dates of service must be within specified ranges for each submission.  Since the geographic component is essential to the data, the service ZIP Code must be a location at which services can be performed and not a billing location, such as a P.O. Box.  Additionally, FAIR Health checks that the modifiers used with procedure codes are valid for such codes, and that all required fields are present and valid.  We exclude negative charges or units.
    About the FH NPIC Standard Analytic Files (FH NPIC SAFs)
  • What are the FH NPIC SAFs?

    The FH NPIC SAFs consist of tailored, claims-level data extracted from our NPIC database as standard analytic files. The claims data in the FH NPIC SAFs are not pre-aggregated and can be requested based on the particular needs of the researcher or institution (e.g., based on year, geographic region, clinical profile).
  • How do the FH NPIC SAFs differ from the FH Benchmarks modules?

    The FH NPIC SAFs contain actual claims data contributed to FAIR Health, which have been validated.  Only data that FAIR Health determines to be erroneous (e.g., data with P.O. Boxes, invalid ZIP Codes) have been removed. The FH Benchmarks modules contain selected categories of aggregated data from the FH NPIC database, which have been subjected to additional methodologies.  These methodologies are described in the FAIR Health Info and Resource Library.
  • How are the FH NPIC SAF datasets structured?

    The FH NPIC SAFs are structured as individual rows, each corresponding to a specific line of a claim submitted by a healthcare provider to a commercial payor.  Separate lines provide the medical or dental procedure being billed, the non-discounted fee-for-service for the procedure, the year in which the service was rendered and other claim elements.
  • Can patients be tracked over time through the FH NPIC SAF dataset?

    At this time the data do not support extended tracking of patients.  FAIR Health is exploring the possibility of adopting new procedures that would facilitate tracking in the future.  
  • How are missing fields identified in a claim in an FH NPIC SAF?

    Missing elements are indicated by a blank field. 
    About the FH® Benchmark Modules
  • What are the FH Benchmark modules?

    The FH Benchmark modules are a suite of aggregated datasets that are organized by service type: medical/surgical, dental, anesthesia, Healthcare Common Procedure Coding System (HCPCS), inpatient facility, outpatient facility, ambulatory surgery centers (ASC) and allowed charges.  The FH Benchmarks modules organize the charge data from the FH NPIC database into percentiles based on geozip (generally the first three digits of a ZIP Code) and relevant procedure code.  A more detailed product description is provided on the STANDARD PRODUCTS  page.
  • How do the FH Benchmarks modules differ from the FH NPIC SAFs?

    The FH NPIC SAFs contain tailored, claims-level data contributed to FAIR Health, which have been validated.  Only data that FAIR Health determines to be erroneous (e.g., data with P.O. Boxes, invalid ZIP Codes) have been removed. The FH Benchmarks modules contain selected categories of aggregated data from the FH NPIC database which have been subjected to additional methodologies.  These methodologies are described in the FAIR Health Info and Resource Library.
  • How are the FH Benchmarks modules structured?

    The FH Benchmarks modules are structured as individual rows containing an array of percentile charges for healthcare procedures identified by medical code (CPT codes or anesthesia codes) or dental code (CDT).  The modules report the charges by geozip, which is generally determined by the first three digits of the ZIP Code where the procedure was performed.
  • What are the categories of information reflected in the FH Benchmarks modules?

    The FH Benchmarks modules are organized according to the geozip where the healthcare procedure was performed (in most cases, a geozip includes all ZIP Codes with the same first three digits) and the relevant code for the procedure (e.g., CPT, CDT, ASA, HCPCS codes).  For each geozip/procedure code combination, the FH Benchmark module indicates the percentile distribution of the billed charges from the FH NPIC database and the mean, median and mode charge values.  Each FH Benchmarks module contains data for a one-year period and includes a detailed description of the fields and format instructions.
    Administrative questions
  • Who is eligible to apply to license datasets from the FH NPIC Database?

    To license datasets, an applicant must be a student, a researcher or an authorized representative of an institution engaged in research with clearly defined topics of study, objectives and methodologies.  Generally, the goal of any project that uses the FH NPIC datasets should be to contribute to general knowledge by disseminating results typically through publication and/or presentation at academic or other types of scientific conferences.   Alternatively, the datasets can be licensed pursuant to an institutional subscription.  An institutional subscription does not require association with any particular research project.
  • Can I speak to someone regarding my questions about the FH NPIC Database?

    To inquire about licensing data for research, please contact FAIR Health at 855-301-FAIR (3247), from 9:00 AM to 6:00 PM Eastern Time, Monday through Friday.
  • Is any training required to download FH NPIC SAFs or FH Benchmarks modules?

    FAIR Health provides a guide to show the researcher the steps to follow in order to download our data products.
  • What fees are charged to license FH NPIC datasets? Are discounts available for doctoral students?

    License fees for the datasets are scaled based upon a number of factors, including the amount of data requested, the term of the license and whether the license will be issued to an individual researcher or to an institution.  General pricing guidelines can be found on the DATA FOR RESEARCHERS page.  Final pricing is determined after a completed Research Application for a dataset has been approved by FAIR Health.  Discounts are available for students.  For more information, please contact FAIR Health by e-mail at service@fairhealth.org or call us at 1-855-301-FAIR (3247), from 9:00 am to 6:00 PM Eastern Time, Monday through Friday.
  • Do the licensing fees cover open-ended use of an FH NPIC dataset during the term of the license, or is use restricted to the single research project described in the Research Application?

    In the case of a license granted to an individual researcher, use of the dataset is restricted to the project(s) described in the completed Research Application.  Any use of the dataset by the researcher beyond that described in the Application requires the submission of an amended Application and must be approved in advance by FAIR Health.  Additional license fees may apply.  In the case of an institutional license, use of the dataset is not restricted to a particular project.  All licenses limit the time period for the use of datasets.
  • How quickly can a dataset be received after an application has been submitted and approved?

    FAIR Health usually finishes the review and approval process within two-to-four weeks after our receipt of a completed Research Application.   If the Application requests aggregated data in the format of the FH Benchmarks modules, the dataset is generally made available within two-to-four weeks following execution of a research license.  If the Application requests underlying claims data provided in the format of a FH NPIC SAF, the dataset is generally made available to approved applicants within four-to-eight weeks following execution of a research license.
  • In what format are the FH NPIC datasets delivered to licensees?

    FH Benchmarks modules are provided as text data files, available in a variety of technical formats.  FH NPIC SAFs are made available in Comma-Separated Values (CSV) text file format.  For both FH Benchmarks modules and FH NPIC SAFs, documentation clearly explains field definitions and record layouts.  An applicant can select digital download or CD/DVD delivery.
    Data Licensing and Use
  • What is the process for licensing data?

    For complete details regarding the application process, visit HOW TO APPLY.

    To begin the process, please contact FAIR Health by e-mail at service@fairhealth.org or call us at 1-855-301-FAIR (3247), from 9:00 AM to 6:00 PM Eastern Time, Monday through Friday.  

    We will work with you to help identify data to support your research project; discuss the cost for your license, which will be based on the data needed; and provide a Research Application for you to complete and submit for FAIR Health’s review and approval.
  • As part of the Research Application approval process, does FAIR Health evaluate the merits of the proposed project?

    FAIR Health does not assess the merits of the proposed research project.  FAIR Health reviews the Research Application only to determine that the project is for research and not commercial purposes, and that the data sought is limited to that reasonably necessary for the research.  For purposes of the FAIR Health research support program, “research” means a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge through the dissemination of findings via publication and/or scientific conferences.
  • If I move to a different organization or institution, can I take the dataset I am using with me?

    An individual licensee can take the dataset to his or her new institution, but must notify FAIR Health in advance in writing of the physical location where the dataset will be located.  No copies of the dataset can be retained at the original location by any other person or entity.  FAIR Health reserves the right to terminate the license if FAIR Health determines that the removal of the dataset is not in the best interest of FAIR Health.

    If an individual is conducting research under an institutional license, the individual cannot take the dataset to the new location nor can he or she have access to the data at the institutional licensee, unless FAIR Health grants permission in writing for the researcher to have such access.
  • Do I need Institutional Review Board (IRB) approval in order to gain access to the FH Benchmarks modules or FH NPIC SAFs?

    IRB approval is not required by FAIR Health for licensing FH Benchmarks modules, as they contain only aggregated, de-identified data.  Likewise, since the FH NPIC SAFs currently do not contain identifiers directly, IRB review is not required for HIPAA-compliance.  However, each researcher must observe the requirements of his or her own institution.  FAIR Health reserves the right to review the proposed project and its purpose, as part of the application process, in order to determine that it qualifies as a research project within FAIR Health’s parameters and that the data sought is appropriately limited.  FAIR Health expects to handle this review quickly in most cases.  In the future, FAIR Health may offer FH NPIC SAFs that contain PHI and will update its requirements accordingly at that time.
  • Can census data and/or other types of research data be merged with the FH NPIC SAFs or FH Benchmarks modules for analysis?

    Yes, but the completed Research Application must specify what data would be merged with the dataset licensed from FAIR Health, and the merged data must continue to constitute either de-identified data or a Limited Data Set, as appropriate, pursuant to HIPAA.  Because the dataset must be returned to FAIR Health at the end of the license term, it must be possible to identify and remove the dataset from computers and files.
    Technical
  • What are the technical requirements for licensing datasets from the FH NPIC Database?

    All datasets will be transmitted to researchers over a secure https channel.  Use of the NPIC SAFs will require the ability to run a Windows self-extracting zip file using a password supplied by FAIR Health.
  • What do I need to know in order to download datasets from the FH NPIC Database?

    Approved researchers will be provided with access to an online portal where data will be downloadable via a secure channel.
  • Are there any training requirements related to downloading a FH NPIC SAFs or the FH Benchmarks modules?

    FAIR Health provides a guide to show the researcher the steps to follow in order to download our data products.

Simple Steps to Licensing Data For Research

 

The process of applying to license FAIR Health data for research includes the following steps:

 

Step 1: Contact FAIR Health by e-mail at service@fairhealth.org or call us at 1-855-301-FAIR(3247), from 9 am to 6 pm ET, Monday through Friday.

 

Step 2: We will work with you to help identify data to support your research project. We will also discuss the cost for your license, which will be based on the data needed.

 

Step 3: We will then provide a Research Application for you to complete and submit for FAIR Health’s review and approval. The Research Application will require the following information:

 

  • Name(s) of and contact information for those you wish to access the data;
  • Description of the project and how the results will be used;
  • Plans for dissemination of results;
  • Other datasets to be used in the research;
  • Data formats;
  • Delivery timeframe; and
  • Source of funding/grants.

 

Step 4: If FAIR Health approves your Research Application, we will provide a FAIR Health Data Use Agreement for you to complete and return.

 

Step 5: After FAIR Health receives your completed FAIR Health Data Use Agreement, we will make available to you the FH NPIC data you requested.


FAIR Health data are used to support a range of research studies. Below are examples of published research that were conducted using FAIR Health data.


Obesity and Type 2 Diabetes as Documented In Private Claims Data
A FAIR Health White Paper


The Impact of the Opioid Crisis on the Healthcare System: A Study of Privately Billed Services
A FAIR Health White Paper


The Opioid Crisis among the Privately Insured
The Opioid Abuse Epidemic as Documented in Private Claims Data
A FAIR Health White Paper


Medical Cost Trend: Behind the Numbers 2017
PWC Health Research Institute


Urgent Care Facilities: Geographic Variation in Utilization and Charges for Common Lab Tests, Office Visits, and Flu Vaccines
Dang, J., Okurowski, E., Gelburd, R., Limpahan, L., Iny, N.


Medical Practice Damage Caps and the Price of Medical Procedures
Friedson, A. I.

Relative Prices, Payer Mix and Regional Variations in Medical Care
Ketcham, J., Lyons, S., Nicholson, S.


Research Opportunities of a New Private Health Insurance Claims Data Set
Nicholson, S.


DENTAL SERVICES: Information on Coverage, Payments, and Fee Variation
US Government Accountability Office


Health Care Price Transparency: Meaningful Price Information is Difficult for Consumers to Obtain Prior to Receiving Care
US Government Accountability Office


Costs and Effectiveness of Genomic Testing in the Management of Colorectal Cancer
See page 175