FAIR Health was established in 2009 as part of the settlement of a broad investigation by New York State into conflicts of interest involving the adjudication of healthcare claims. FAIR Health was expressly created to bring transparency, integrity, reliability and accessibility to healthcare costs and insurance information for all healthcare stakeholders.

FAIR Health possesses the nation’s largest, independent, private healthcare claims database. FAIR Heath is not affiliated with any governmental agency, insurer or other organization in the healthcare sector.

FAIR Health is widely regarded as a trusted and neutral provider of robust data and data tools by diverse stakeholders throughout the healthcare sector. FAIR Health produces a variety of actionable data resources, including standard cost benchmarks to reflect in-network and out-of-network billing and payment practices for specific procedures, and custom analytics and tools to reveal provider performance, epidemiological trends, treatment protocols, healthcare system transformation, reimbursement practices and the efficacy of public health interventions, among other uses.

FAIR Health serves a broad range of healthcare stakeholders, including federal and state governmental entities, payors and providers alike, as well as consumers.

For more information, visit the Who We Serve section of the website.

Because of our reliability and objectivity, FAIR Health’s data are relied upon by various stakeholders from all parts of the healthcare ecosystem as a neutral data source. Our data support licensees in developing out-of-network usual and customary rate (UCR) fee schedules, claims adjudication, network and benefit design, market research, dispute resolution, policy development and more. And our benchmarks have been incorporated into statutes and regulations around the country and designated as the official, neutral data benchmark for a variety of state health programs.

Visit Solutions to learn how your organization can use FAIR Health data.

To keep abreast of news about FAIR Health, you may subscribe to receive FAIR Health newsletters, including FAIR Health Access®, for the latest product news and insights into the uses of FAIR Health data; FAIR Health Consumer Access®, for tips on navigating the healthcare system and estimating the real cost of healthcare; and FAIR Health Research Recapâ„¢, which features this year’s publications utilizing FAIR Health data in studies developed by the FAIR Health team as well as external researchers. You can also connect with us through social media on Facebook, LinkedIn, X and YouTube.

FAIR Health obtains its data from more than 75 health plans, insurance carriers and third-party administrators, which contribute both billed charge amounts and in-network allowed amounts from both self-insured and fully insured plans through the FAIR Health Data Contribution Program described below.

The FAIR Health National Private Insurance Claims (FH NPIC^®) database is made up of de-identified data from billions of privately billed claims for medical and dental services submitted by healthcare professionals to health insurers across all 50 states; Washington, DC; Puerto Rico; and the US Virgin Islands. The database grows continually as new data are received each month. A subset of the dataset includes de-identified members that can be tracked longitudinally.

In addition, FAIR Health has been certified by the Centers for Medicare ' || '&' || 'amp; Medicaid Services (CMS) as a national Qualified Entity (QE), and entrusted with the complete collection of Medicare Parts A, B and D claims for all individuals across the country enrolled in traditional Medicare from 2013 to the present-a collection of over 53 billion claim records. The QE data is maintained and stored separately from the commercial claims database. Only commercial rates are used to calculate allowed amounts in FAIR Health data products.

FAIR Health places the highest priority on patient privacy and the security of our contributors’ data. We apply rigorous protocols to de-identify personally identifiable patient information, in accordance with HIPAA. FAIR Health data products include only aggregated, patient de-identified data. To learn more about how we protect and secure patient data,visit Security.

FAIR Health applies rigorous quality assurance processes to validate data before they are accepted by the FAIR Health Data Contribution Program and added to the repository. Each data submission undergoes a series of thorough edit checks by in-house experts in statistics, mathematics and information technology. Part of this process involves comprehensive statistical testing to assure that invalid entries are eliminated. For example, FAIR Health identifies and quarantines claims data with invalid dates of service and/or invalid zip codes. To learn more, visit Validation.

FAIR Health collects most data fields reported on medical and dental claims, including diagnoses, procedures, dates and places of service, billed charges, allowed amounts reimbursed and other information. All types of services are captured in the repository, including lab services, surgeries, radiology, durable medical equipment, emergency services, behavioral health, ambulance services, specialty drugs, primary care and the like.

The FAIR Health database includes claim records from all geographic areas in the United States and its territories, including all 50 states; Washington, DC; Puerto Rico; and the US Virgin Islands. FAIR Health’s repository does not include claim records from outside the United States. The geographic location in our data indicates where the service was rendered. FAIR Health’s FH® Benchmarks are organized into 493 geozips, which tend to track with the first three digits of a zip code. Click here to download a complete listing of geozips. Other FAIR Health data products may configure data by state, rural/urban, census region, medical service area or other geographical regions.

Yes. CMS, a division of the US Department of Health ' || '&' || 'amp; Human Services, has determined that FAIR Health’s commercial data collection is statistically significant and representative for all 50 states and the District of Columbia.

FAIR Health makes its data available as aggregated, de-identified datasets, in a range of formats for a variety of stakeholder groups. These include benchmark data products, custom analytics and consumer engagement tools. FAIR Health also offers a separate website for consumers at fairhealthconsumer.org (fairhealthconsumidor.org in Spanish), with mobile versions available through the App Store and Google Play. You can learn more by visiting the Solutions section.

FAIR Health offers FH Benchmarks, a suite of data products that aggregate, compile and report charges and allowed amounts from claim records in the FAIR Health database by official healthcare code and geozip, and array benchmarks for each procedure code/geozip combination into percentiles. The FH Benchmarks include two distinct product lines: (1) the FH® Charge Benchmarks, which report benchmark percentiles based on the actual, non-discounted charges as billed by providers; and (2) the FH® Allowed Benchmarks, which report benchmark percentiles reflecting the negotiated or “in-network” allowed amounts. A complete list of products can be found in the Benchmark Data Products section.

FAIR Health’s standard benchmark products are updated with current data every 6 months (twice a year) and are based on a recent 12 consecutive months of data.

Many procedures are rare or are infrequently performed in certain geographic areas. To address small cells (i.e., procedures performed at a very low frequency in a particular geographic area), FAIR Health employs an industry standard derived or relative value methodology. To learn more, visit the Methodologies section..

Because of FAIR Health’s role as a neutral and independent data source for use by all stakeholders, FAIR Health itself does not dictate, determine or set what “usual and customary rates” (UCR) or “reasonable values” are for any procedure or service. However, users may rely on FAIR Health benchmark data products to render their own recommendations or determinations regarding UCR or valuation.

FAIR Health staff work with our clients to create custom data analyses and aggregated datasets to meet their specific needs. We also create interactive data dashboards and visualizations that illuminate findings. To learn more, visit the Custom Solutions and Market Reports sections

The claims data that FAIR Health receives are contributed by insurance payors and third-party administrators voluntarily through the FAIR Health Data Contribution Program. In consideration of their contributions, contributors receive credits against license fees for FAIR Health data products, as well as other incentives, such as complimentary data reports. By contributing their data, these organizations know that their claims experience is represented in the aggregated data that support a growing list of statutes, regulations and official memoranda incorporating FAIR Health data as a governing benchmark. Moreover, a large data pool makes FAIR Health data products truly representative of the private insurance market and enables FAIR Health to develop new data products and custom analytics to serve the healthcare industry and its many stakeholders.

Health plans, insurance carriers and third-party administrators may contribute claims data to FAIR Health. Although FAIR Health cannot accept claims submissions directly from healthcare practitioners, due to the high probability that provider claims will result in the duplication of data already within the database, FAIR Health receives healthcare providers’ non-discounted billed charges indirectly from its contributors as part of the Data Contribution Program. To learn more about data contribution, visit the Data Contribution section.