FAIR Health is a national, independent, nonprofit organization whose mission is to bring transparency to healthcare costs and health insurance information through comprehensive data products, consumer resources and the support of health services research.
FAIR Health uses our database of billions of billed medical and dental services to:
- Power an award-winning, free website (fairhealthconsumer.org) that enables consumers to estimate and plan their medical and dental expenditures. FAIR Health Consumer also offers clear, unbiased educational articles and videos about the healthcare insurance reimbursement system. Our cost lookup tools and educational material about healthcare costs and insurance are offered in Spanish at fairhealthconsumidor.org and as mobile versions through Apple’s iTunes store and, for Android devices, Google Play.
- Create data products, custom analytics and interactive data dashboards that we license to businesses, government agencies, policy makers, healthcare providers, researchers and others. With our professional staff of experts in healthcare, statistics, technology and communications, FAIR Health strives to offer information to all stakeholders in the healthcare sector.
FAIR Health was founded in 2009 after then-New York State Attorney General Andrew Cuomo uncovered potential conflicts of interest in the methods that health insurers were using to determine reimbursements to patients who received care from providers outside their health plans’ networks. The Office of the Attorney General reached settlement agreements with health insurance companies that do business in New York State; those agreements focused on bringing fairness and transparency to the out-of-network reimbursement system.
FAIR Health was established as part of this settlement. Our mandate was to create and maintain a new database of charge data for healthcare procedures, to offer consumers tools to make it easier for them to estimate out-of-network expenses and to make our data available for academic research.
While the investigation took place in New York, the settlement had national implications. Since our inception, FAIR Health has established a national reputation for bringing cost transparency to the healthcare sector. FAIR Health data currently power a range of data tools that are used by healthcare stakeholders across the nation.
The settlement agreement reached with 12 health insurers (see “Why was FAIR Health formed?” above) focused on bringing fairness and transparency to the out-of-network reimbursement system by creating a non-industry, independent repository of claims data that would be overseen by a nonprofit organization. FAIR Health was formed to establish that database and oversee the ongoing contribution of claims data to it.
FAIR Health is committed to promoting transparency in healthcare costs and health insurance information through comprehensive data products, custom analytics, interactive data visualizations and consumer resources. As an independent, unbiased source of healthcare cost information, FAIR Health is the trusted data provider to a wide range of customers, including payors, healthcare professionals, government agencies, unions, consultants, pharmaceutical companies, employers, consumers and researchers.
FAIR Health serves a broad range of healthcare stakeholders in various industries, among them:
- Life sciences;
- Academics and research;
- Associations & medical societies;
- Property and casualty; and
Stakeholders use FAIR Health data in a great variety of ways. Some examples include:
- Out-of-network (UCR) fee schedule development;
- Reference point for legislated consumer protections and state health programs;
- In-network fee schedule development;
- Workers’ compensation and auto liability program fee schedule development;
- Claims adjudication;
- Cost transparency tools;
- Public and private exchange plan selection and management;
- Employee and member education;
- Reimbursement risk management;
- Network design and provider recruitment and negotiations;
- Provider fee schedule evaluation;
- In-network and out-of-network cost comparisons;
- Healthcare cost projections;
- Market research;
- Sales and inventory planning;
- Litigation support;
- Research and policy development;
- All Payer Claims Database (APCD) and Centers for Medicare & Medicaid Services (CMS) Data Center development and maintenance; and
- Government fee schedule development.
FAIR Health obtains our data from more than 60 health plans, insurance carriers and third-party administrators who contribute claims data through the FAIR Health Data Contribution Program described below.
The FAIR Health data repository 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 the nation. The database includes over 30 billion billed procedures, from 2002 to the present. The database grows continually as new data are received each month; we receive approximately two billion new claims each year. The data are submitted to FAIR Health by healthcare payors that collectively insure over 150 million individuals in the private (i.e., non-government sponsored) healthcare system.
In addition, because FAIR Health is certified by CMS as a Qualified Entity (QE), FAIR Health receives all of Medicare Parts A, B and D claims data for use in nationwide transparency efforts. As a QE, FAIR Health holds data representing the experience of all individuals enrolled in traditional Medicare from 2013 to the present (as well as Medicare Advantage enrollees represented in our private claims data). FAIR Health can produce insightful analytic reports and data products based on combined Medicare and commercial claims data for government, providers, payors and other authorized users.
FAIR Health places the highest priority on the security of our contributors’ data. We apply rigorous protocols to de-identify all personally identifiable patient information, in accordance with the Health Insurance Portability and Accountability Act (HIPAA) “safe harbor” rule and other requirements. We also exclude from our data products any personal information that could identify a specific patient, provider, plan or contributor. To learn more, visit Security.
FAIR Health owns and manages the database and works with advisors from the academic and research community to refine the statistical methodologies and algorithms that are employed to develop and enhance the value of our products.
FAIR Health applies rigorous quality assurance processes to validate data before they are accepted by the FAIR Health Data Contribution Program and added to our repository. Each data submission undergoes a series of thorough edit checks by in-house experts in statistics, mathematics and information technology to help prevent flawed data from being included. Part of this process involves testing the data with statistical algorithms to ensure that invalid entries are eliminated. For example, FAIR Health identifies and quarantines claims data with invalid dates of service and/or invalid zip codes. If data fail to pass the edit checks, FAIR Health will contact the data contributor to address the source of errors or concerns. To learn more visit Validation.
FAIR Health employs a proprietary extreme outlier methodology to detect and remove data entries that represent invalid charge data.
To address small cells (i.e., procedures performed at a very low frequency in a particular geographic area), FAIR Health employs Relative Value Methodology. To learn more, visit the Methodologies section.
The FAIR Health database includes billed charges 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 billed charges from outside the United States. FAIR Health data 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.
Most FAIR Health modules are refreshed twice yearly to reflect new data collected and included in the FAIR Health claims database. FH® Allowed Dental, FH Allowed Anesthesia, FH Allowed Outpatient Facility and FH Allowed HCPCS are updated on an annual basis. Product modules include 12 months of data that are updated for each release. The cutoff date for data to be included in a module is three months prior to the release date.
No. FAIR Health offers benchmark data to assist insurers in establishing usual and customary rates (UCR) for out-of-network reimbursement. FAIR Health does not set UCR rates or out-of-network reimbursement amounts; those determinations are made by insurers themselves. FAIR Health data are intended to inform those decisions.
FAIR Health Products and Solutions
FAIR Health makes its data available in a range of formats to a variety of stakeholder groups. We offer standard data products, episodes of care products, custom analytics and consumer engagement tools. FAIR Health also offers a separate website for consumers at fairhealthconsumer.org (fairhealthconsumidor.org in Spanish.) You can learn more by visiting the Solutions section.
FAIR Health staff work with our clients to create custom cuts of data that meet their specific needs. We also create interactive data dashboards and visualizations that illuminate findings. Examples of customized analyses include:
- Custom geographic areas—national, regional, state and local—and geozip combinations;
- Custom groupings of procedure codes;
- Analysis of service utilization patterns; and
- Data for specific time periods.
Our clients rely on the FAIR Health database to provide a rich array of geographically specific benchmark data. The claims data that FAIR Health receives are contributed by payors through the FAIR Health Data Contribution Program. Contributors receive credits against their license fees for FAIR Health data products, as well as other incentives. In addition, by contributing their data, these organizations ensure that their claims experience is represented in the tools that FAIR Health offers the industry. 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 to serve the healthcare industry and its many stakeholders.
For the reasons stated below, participation in the FAIR Health data contribution program is limited to the following types of organizations, provided that they are current licensees of FAIR Health data products:
- Health plans;
- Insurance carriers; and
- Third-party administrators.
FAIR Health regrets that it cannot accept claims submissions from healthcare practitioners, due to the high probability that provider claims will not be unique and will result in the duplication of data within the database.
After you sign up as a contributor, the FAIR Health data team will work closely with you to establish and test the file transfer protocols in order to get your organization’s data contribution up and running quickly and easily according to contribution guidelines. We also will monitor your contribution feeds and provide guidance as needed.
FAIR Health offers credits that reduce data licensing fees to qualified data contributors. Data credits will offset licensing fees for the next renewal term after the data are accepted by FAIR Health. Participants in the data contribution program can earn credits of up to 50 percent of licensing fees for each product renewal term beginning after the data are accepted into the program. Credits are based on the number of accepted claims and vary depending on the type of data provided. Data contributors are also eligible to choose from certain complimentary data reports that offer valuable market insights.
Yes, FAIR Health provides all contributors with telephone-based training for the initial setup and ongoing data submission process.
FAIR Health Support
FAIR Health offers varying levels of assistance to clients, including answers to questions about our data and methodologies, training sessions and webinars via conference call, and specialized support that includes on-site training and hands-on assistance with a variety of service, product and client education topics. To learn more, visit the Support section.