FAIR Health Receives Nationwide Medicare Claims Data

May 01, 2017

Already recognized for maintaining the nation’s largest database of privately billed claims, FAIR Health is now also receiving complete, nationwide Medicare claims data, as a result of our designation as a Qualified Entity (QE). FAIR Health is one of only four organizations certified by the Centers for Medicare & Medicaid Services (CMS) under its Qualified Entity Certification Program (QECP) to receive Medicare Parts A, B and D claims data for all 50 states and the District of Columbia. To date, we have received from CMS 100 percent of claims for Medicare Parts A and B services rendered nationwide from January 2013 through September 2016, and all Part D claims, from 2013 through 2015. We expect to receive the balance of the data by April 2017, giving us four full years of Parts A, B and D claims from 2013 through 2016. Moving forward, we are scheduled to receive Parts A and B data quarterly and Part D data annually.

The claims we are receiving from CMS represent the experience of more than 55 million individuals enrolled in Medicare Parts A and B coverage. These claims will supplement FAIR Health’s collection of private claims from both fully insured and self-insured plans that represent 150 million individuals. FAIR Health thus holds data assets that present a uniquely comprehensive perspective on healthcare costs and utilization across the country.

As part of our QE responsibilities, FAIR Health will produce and publish public quality reports and data analytics—based on our database of private insurance claims, in combination with Medicare information—to support efforts to promote transparency, improve the quality of care and reduce costs. FAIR Health also plans to use the Medicare data for internal analyses that will contribute to the evolution of our products and analytics and enrich our offerings in support of transparency in policy making and health systems research.

Reports Available for Clients Who Contribute Data

With our QE designation, we also are able to create, for clients who contribute their private claims data to FAIR Health, non-public aggregate reports that reflect information from Medicare Parts A, B and D claims data. The reports will incorporate privately billed claims data from our vast repository and/or the client’s own data. These types of comprehensive analyses can open up a broad range of opportunities for an organization to evaluate its claims data for strategic, operational, clinical, budgetary and other purposes.

FAIR Health President Robin Gelburd remarked, “FAIR Health’s QE certification demonstrates the trust the healthcare sector places in our data security and mission-driven activities. It also gives us the opportunity to conduct analyses incorporating vast amounts of Medicare and private claims data, offering a unique, overarching perspective on the workings of the healthcare system today.”

For more information about public and private reports incorporating Medicare claims information, e-mail us at service@fairhealth.org or call us at 855-301-3247, Monday through Friday, 9 am to 6 pm ET.