Custom Solutions

Surprise Billing Solutions from FAIR Health:

Several states have enacted laws to protect consumers from “surprise billing” and the federal No Surprises Act (NSA) takes effect on January 1, 2022. FAIR Health currently offers solutions for a number of individual states’ surprise billing laws and has developed an offering to support the “Qualified Payment Amount (QPA)” provisions of the NSA. This FAIR Health suite of products is a valuable resource to assist health plans, providers and arbitrators in determining reimbursement amounts under these laws.

State Solutions

Many states have laws that protect patients from balance billing, and the scope of these protections varies. FAIR Health data serve as the independent, official data source for surprise billing laws in the following states:

  • Connecticut
  • Georgia
  • New Mexico
  • New York
  • Texas

Many organizations rely on FAIR Health benchmarks, including in states that do not specifically refer to FAIR Health in their statutes or regulations.

Support for the Federal No Surprises Act (NSA)

The federal NSA applies to health plans in states that do not have a specific state law concerning surprise bills, and to self-insured health plans that are not covered by such state laws. For plans subject to the federal law, FAIR Health can offer data and software tools to support the determination of Qualifying Payment Amounts (QPA) under the NSA.

FH NPIC® Claims Data

The FH NPIC (National Private Insurance Claims) database—our industry-leading collection of privately billed medical and dental procedures—is based on data contributions from payors nationwide. FAIR Health collects all data fields reported on medical and dental claims, including diagnoses, procedures, dates and places of service. FAIR Health licenses de-identified, aggregated datasets where appropriate for academic, policy and commercial research.

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Custom Analytics

One size does not fit all. Beyond our standard FH® Benchmarks, the size and breadth of the FH NPIC database make it possible to view and organize our data in countless ways to meet a wide array of business needs. Customized analytics can be created to your specifications.

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