Healthcare policy at all levels—national, state, municipal‐is in flux. As the steward of healthcare claims covering more than 150 million privately insured individuals, FAIR Health offers data that paint a clear picture of how the healthcare system is operating today and lay the foundation for informed decisions to effect positive change. Because FAIR Health is known nationwide to be neutral and conflict-free, our trusted, representative claims data can be used to support varied legislative proposals and perspectives. Indeed, state agencies and legislative bodies responsible for a broad range of initiatives frequently turn to FAIR Health data as an invaluable resource for advancing their goals. New York and Connecticut have already enacted legislation using FAIR Health benchmarks as the reference point for consumer protection laws and more than 20 other states have approached FAIR Health for support with their plans to advance similar proposals.

Strategic uses for FAIR Health data by healthcare policy makers include:

• Consumer protection laws and regulations;
• Research of intended and unintended consequences of statutes, regulations or public health initiatives;
• Medicaid fee schedule re-evaluation;
• Workers’ compensation fee schedule support;
• Auto liability personal injury protection (PIP) reimbursement standards;
• Population health studies based on de-identified member data;
• Analysis of the implications of value-based reimbursement on healthcare cost and quality;
• Development of reimbursement standards for personal injury protection (auto liability); and
• Consumer healthcare cost transparency initiatives.

With the vast number of claims for healthcare services filed each year, disputes related to reimbursement are inevitable. When reimbursement decisions are challenged, FAIR Health stands behind our data. FAIR Health helps clients understand our data and how they are developed, and provides guidance in applying that knowledge to assist clients in resolving reimbursement disputes. When claims are subject to appeal, or advance to mediation, arbitration or litigation, our expert client services and legal teams are available to provide training in FAIR Health’s methodologies, and can equip clients and their counsel with the statistical and evidentiary support needed to respond effectively to reimbursement disputes.

FAIR Health can support clients in multiple ways, for example:

• Education. Methodology training for clients’ staff and their counsel can be delivered via webcast or as an on-site presentation;
• Statistical analyses. Case-specific support is available, including analysis and preparation of data, statistical information and illustrative exhibits; and
• Evidentiary support. Client assistance is also available should additional evidentiary support be needed to validate FAIR Health’s data or explain our methodologies.