Claims Data

Latest Headlines

Latest Headlines

The importance of claims databases to control costs

Well before implementation of the Affordable Care Act, a handful of states--including Maine, Maryland and Massachusetts--created all-payer claims databases (APCD), according to Stateline. The APCDs collect claims data from all commercial insurers within their borders to detect price discrepancies among doctors and hospitals.

GAO: State Medicaid payments vary for identical services

To help policymakers ensure adequacy of Medicaid provider payments, the U.S. Government Accountability  Office assessed how widely state Medicaid payments vary for the same services, and how closely Medicaid provider payment rates calculated from claims data match rates reported in states' Medicaid fee schedules.

UnitedHealth, Mayo combine data to research medical treatments

UnitedHealth and Mayo Clinic have agreed under a new partnership to combine their data for more than 110 million patients to help research methods to improve healthcare while lowering costs.

Consumer engagement: Helping members help themselves

As insurers continue to grapple with rising healthcare costs, they're faced with an increasingly unhealthy member population. So payers have started taking matters into their own hands to engage members into becoming stewards of their own health and wellnes.

CMS opens up Medicare claims data for provider quality reports

In a move toward transparency and quality improvement, the Centers for Medicare & Medicaid Services (CMS) yesterday announced a final rule that will allow consumers, insurers, and employers to