FAIR Health Can Configure Its Data to Reflect Multiple Geographic Groupings
January 21, 2025
FAIR Health offers custom analyses of data from its data repository—the largest of its kind in the nation—to reflect different geographic groupings, thus helping to meet the needs of various healthcare stakeholders seeking to understand and serve the healthcare system at varying levels of geographic granularity.
FH NPIC® Geographies
To create its FH® Charge Benchmarks and FH® Allowed Benchmarks, FAIR Health analyzes, aggregates, compiles and reports charge or allowed data, as applicable, from its FH NPIC database for specific medical procedures and services in 493 local areas across the country. These local areas, called geozips, tend to track with the first three digits of a zip code. However, FAIR Health can also create custom benchmarks using other geographic regions such as state values, rural/urban clusters, census regions, medical service areas, Medicare carrier localities and metropolitan statistical areas (MSAs).
The No Surprises Act (NSA) and the Use of MSAs
The federal NSA, which went into effect in 2022, specified the use of MSAs and other regions defined in relation to MSAs for use when health plans are calculating the qualifying payment amount (QPA) or median contracted rate for an item or service. FAIR Health’s FH® NSA Reference File offers commercial, in-network, benchmark allowed amounts for these NSA-specified regions—including individual MSAs, state-level MSA and non-MSA areas, and census division-level MSA and non-MSA areas—which can be used to help health plans calculate the QPA.
Stakeholders may also be interested in using FAIR Health’s allowed data in connection with NSA proceedings, beyond the calculation of QPAs. For example, disputing parties can support their offers under the NSA independent dispute resolution (IDR) process, by submitting pricing information from databases that do not include any prohibited factors under the statute (e.g., billed charges, UCR and rates that would have been paid by a public payor). FAIR Health’s FH NSA Reference File and FH Allowed Benchmarks reflect the allowed amounts negotiated between commercial payors and in-network providers—not prohibited factors such as provider-billed charges, UCR or public payor rates (such as Medicare and Medicaid)—in MSA-based regions and geozips, respectively. In addition, FAIR Health can customize its existing FH Allowed Benchmarks to deliver a range of allowed amount percentiles by other custom geographic groupings, if desired.
Other Custom Geographic Groupings
Other custom zip code mappings can be produced based on regulatory definitions or client specifications. For example, FAIR Health currently provides custom geography benchmark offerings in relation to state-defined regional units for state fee schedules; client-defined custom zip code groupings for health plan geographies of interest; and custom geographies reflecting medical service referral regions for specific sets of services. FAIR Health can also produce mappings that tie to particular medical service areas, such as hospitals, surgery centers, radiology centers and specialty practices, among others. This may help stakeholders define the areas from which they draw patients and investigate spending and utilization in the market. Clients can use this information to help determine where to introduce or expand specific medical services to meet market need and maintain or improve their competitiveness.
FAIR Health clients can determine the geographic areas within which they wish to aggregate data, and FAIR Health can custom configure the data as appropriate, consistent with applicable patient privacy laws. These and other FH® Custom Analytics are available upon request.
For more information on FAIR Health’s repository and how it can be configured by geographic groupings, contact us by email at info@fairhealth.org or call us at 855-301-FAIR (3247), Monday through Friday, 9 am to 6 pm ET.