What is Claims Data?

Claims data, also referred to as administrative data, is a type of medical health record. Whenever you see a doctor, the information submitted into your health records can be classified as claims data. Collecting various types of information, claims data can include data about doctor’s appointments, bills, insurance information, and other patient-provider interactions.

How is this used?

Most often, claims data finds its user in researchers. Researchers can utilize claims data in a variety of ways, including cost analysis and other economic studies, health research, and insurance investigation.

For instance, the National Library of Medicine took claims data to conduct a research comparing the prices for hospital insurance and medical insurance for the average payment per enrollee of Medicare by number of chronic conditions. The first image shows hospital insurance average cost. The second shows medical insurance average cost.

FAQ

What is the source of claims data?

Claims data comes directly from notes made by the provider. This has many benefits, since it’s highly personalized, less likely to be incorrect, and comes from an expert source. However, the downside is that illegal billing processes, such as ordering unnecessary tests, billing double, or billing for a procedure not executed, may infringe on the validity of the data.

What is the difference between open and closed claims data?

Open claims data refers to claims data about healthcare transactions still in progress. For instance, if you attend the hospital for several days and a doctor records your data, it is open claims data until your transaction is complete. Once the transaction ends, it becomes closed claims data.

Conclusion

We hope this article answered all your claims data questions! At Fairdoc, we are here to inform you, assist you, and answer all your questions. If you have any inquiries for us, feel free to reach out, and stay tuned for future articles!