Who We ServeGovernment

Government

A Neutral, Recognized Foundation for Public Programs and Policies

FAIR Health statistical data and custom analytics are relied on by government policy makers nationwide. Numerous government agencies use our independent, conflict-free healthcare cost and utilization data as a reference point when setting new healthcare cost policies and regulations, evaluating existing standards, processing claims for government-sponsored health programs, supporting benefits administration for government employees and much more.

Our FH® Benchmarks provide an array of current, objective data points reflecting providers’ charges and allowed amounts used by insurers when paying claims for services in geographically specific areas. FAIR Health can create FH Custom Analytics of the underlying data to meet particular needs. The many uses of our data by government entities include:

  • Establishing benchmarks for medical fees for balance-billing legislation;
  • Measuring the impact of statutes, regulations or public health initiatives by comparing before-and-after snapshots, using the FH NPIC® (National Private Insurance Claims) longitudinal line-level data;
  • Developing or updating workers’ compensation fee schedules;
  • Setting reimbursement standards for personal injury protection (PIP), i.e., auto liability insurance;
  • Evaluating Medicaid fee schedules for cost and access issues;
  • Assessing Medicaid network adequacy in terms of practitioner specialty and geographic coverage;
  • Adjudicating claims for government employee medical and dental plans;
  • Referencing our benchmarks to assist with dispute resolution proceedings;
  • Valuing indemnity funds;
  • Framing public health education campaigns and interventions;
  • Setting legislative priorities; and
  • Identifying emerging clinical trends.

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User Story

Estimating the Cost of Beneficiaries’ Long-Term Medical Care
Government agencies that oversee care for individuals with disabilities or special needs require data to support projections of the cost of care over the long term. Using FAIR Health’s data, a government agency can estimate long-term and even lifetime treatment costs so that appropriate funds are reserved. And, by using our FH Episodes of Care Benchmarks, analysts can look at costs for the full range of services related to many types of injuries and conditions—adjusted by common patient risk profiles and comorbidities—providing a more complete view of potential treatment costs.

As an independent, tax-exempt organization that qualifies as a public charity under section 501(c)(3) of the Internal Revenue Code, FAIR Health does not lobby or take a position on legislative or regulatory proposals.