Nation’s Largest Private Healthcare Database Acquires All Medicare Claims Data

Managed Care Weekly Digest

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- Newswire/ -- FAIR Health announced that as a result of its designation last year by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity (QE), it is adding four full years of Medicare claims data to its database of more than 23 billion private healthcare claims. FAIR Health is one of only four organizations certified by CMS under its Qualified Entity Certification Program (QECP) to receive Medicare Part A (hospital and facility services), Part B (medical services) and Part D (prescription drug services) claims data for all 50 states and the District of Columbia. To date, FAIR Health has received from CMS 100 percent of claims for Parts A and B services rendered nationwide from January 2013 through September 2016, and all Part D claims from 2013 through 2015. FAIR Health expects to receive the balance of the data by April 2017, giving the organization all Parts A, B and D claims from 2013 through 2016. Moving forward, FAIR Health is scheduled to receive Parts A and B data quarterly and Part D data annually (see also FAIR Health).

CMS is providing FAIR Health with claims that represent the experience of more than 55 million individuals enrolled in Medicare Parts A and B coverage. These claims will supplement FAIR Health's collection of private claims from both fully insured and self-insured plans that represent more than 150 million individuals. FAIR Health regularly receives private claims from approximately 60 of the country's national and regional commercial insurers and thus holds data assets offering a uniquely comprehensive record of healthcare costs and utilization across the country. FAIR Health's private claims database now includes more than 23 billion medical and dental records dating back to 2002, with more than 2 billion private claims added each year.

Public and Non-Public Reports to Include Medicare and Private Claims Data

As part of its QE responsibilities, FAIR Health will produce and publish public quality reports and data analytics-based on its database of private insurance claims, in combination with Medicare information-to support efforts to promote transparency, improve the quality of care and reduce costs. FAIR Health also plans to use the Medicare data for internal analyses that will contribute to the evolution of its products and analytics and enrich its offerings in support of transparency in policy making and health systems research.

In addition, with its QE designation, FAIR Health is able to create, for clients who contribute their private claims data to FAIR Health, non-public aggregate reports that reflect information from Medicare Parts A, B and D claims data. The reports will incorporate data from the privately billed claims from the vast FAIR Health repository and/or the client's own data. These types of comprehensive analyses can open up a broad range of opportunities for an organization to evaluate its claims data for strategic, operational, clinical, budgetary and other purposes.

FAIR Health President Robin Gelburd remarked, "FAIR Health's QE certification demonstrates the trust the healthcare sector places in our data security and mission-driven activities. It also gives us the opportunity to conduct analyses incorporating vast amounts of Medicare and private claims data, offering a unique, overarching perspective on the workings of the healthcare system today."

Keywords for this news article include: Medicare, FAIR Health, Health Policy.