FAIR Health Helps States with PIP Fee Schedules

October 19, 2023

FAIR Health helps states with many kinds of official fee schedules, including fee schedules for personal injury protection (PIP), which covers medical expenses related to automobile accidents. Currently, FAIR Health is assisting Michigan and New Jersey with such auto liability fee schedules.

FAIR Health has extensive experience with fee schedules in such varied areas as workers’ compensation, crime victims’ funds, women’s wellness and cancer screenings, and a medical indemnity fund for birth-related neurological injuries. We bring our independence and expertise to bear in helping states with auto liability fee schedules. We assist with new fee schedule development or assist states with incorporating updates into existing rate tables and guidelines. In serving states with fee schedule development, we reference in-network and out-of-network values from our vast private insurance repository—which gets enhanced by more than two billion medical and dental services every year—and develop comparisons to a state’s fee schedule.

One example of our auto liability work can be found in Michigan. The Michigan Department of Insurance and Financial Services selected FAIR Health data for use in its review of payment determination appeals under Michigan’s no-fault auto insurance reform legislation. FAIR Health is providing the Michigan Department of Insurance and Financial Services with average charge amounts for relevant codes in all 12 Michigan geozips (geographic areas typically corresponding with the first three digits of a zip code) from FAIR Health’s data that include dates of service on January 1, 2019, for use in connection with these appeals.

FAIR Health is agnostic as to the methodologies used to develop fee schedules. We work with multiple state fee schedules using methodologies based on Medicare, gap filling services that are not valued by Medicare and employing private health insurance as a foundation—and many combinations thereof, dependent on the priorities articulated by state officials. Based on a state’s needs, certain methodologies may be more suitable than others. Because we work with multiple states and have assisted with a wide variety of fee schedule designs, we are often able to outline various modes and alternatives for consideration.

In addition, FAIR Health can help collect stakeholder feedback, do research and comparative analysis on that feedback, provide relevant information to the state to make decisions based on that feedback and, finally, present the information back to stakeholders in conjunction with the state. As a trusted source of data and information for all stakeholders, we bring credibility and neutrality to our fee schedule work. Accordingly, we are able to contribute data and ideas that can help build consensus and trust in the fee schedule.

FAIR Health President Robin Gelburd stated: “FAIR Health has earned a reputation for being an independent and trusted resource to assist with the development and updating of fee schedules, including those for auto liability. Our ability to bring all stakeholders to the table and evaluate multiple data sources and fee schedule models has helped states publish fee schedules that are relied upon and reduce disputes.”

For more information about the services and data products FAIR Health offers to state and federal agencies, including those related to auto liability fee schedules, contact FAIR Health by email at info@fairhealth.org or call 855-301-FAIR (3247), Monday through Friday, 9 am to 6 pm ET.