FAIR Health

What FAIR Health does

FAIR Health is an independent, nonprofit organization founded in October 2009 that operates the nation's largest repository of private healthcare claims data, licensed to more than 1,500 organizations across payors, providers, government agencies, life sciences companies, researchers, legal entities, and individual consumers. The company's core technology asset is the FH NPIC (National Private Insurance Claims) database, containing over 54 billion de-identified commercial medical and dental claim records contributed by more than 75 health plans, insurance carriers, and third-party administrators, growing at over 4 billion claims per year. As a CMS-certified Qualified Entity, FAIR Health also holds over 53 billion Medicare Parts A, B, and D claim records covering all individuals enrolled in traditional Medicare since 2013, with HITRUST CSF and SOC 2 Type 2 certifications for protected health information handling.

The product architecture is platform-plus-modules: a core benchmarking engine (FH Charge Benchmarks and FH Allowed Benchmarks) covering 493 geographic regions and modular offerings including FH Total Treatment Cost for episode-based pricing, FH Medicare GapFill PLUS for CMS fee schedule consolidation, FH Online query tool, and FH Fee Estimator for individual practitioners. Market intelligence products include the FH Healthcare Indicators report, FH Medical Price Index, and interactive trackers for telehealth, opioid use disorder, and cost of giving birth. The FH NSA Reference File, built specifically for federal No Surprises Act compliance, represents a regulated product line embedded in state and federal statutes (Connecticut, Georgia, New Mexico, New York, and Texas surprise billing laws). Consumer-facing offerings include the FAIR Health Consumer website (English and Spanish) and FH Consumer Classroom mobile app, which can also be white-labeled under partner branding.

FAIR Health monetizes primarily through B2B data licensing on an enterprise subscription basis, supplemented by grant-funded initiatives from foundations including The John A. Hartford Foundation and The New York Community Trust, private-label consumer tool licensing, and custom analytics services. The organization sells via direct enterprise sales (1-855-301-FAIR), a client portal, and self-serve tools including the consumer website, fee estimator, and API/feeds for integration into member portals. As a 501(c)(3) public charity, FAIR Health has an uncompensated Board of Directors and operates without the conflict-of-interest profile of any insurer, provider, or government stakeholder—providing the neutrality that underpins its regulatory designations and customer trust.

Name

FAIR Health

Legal name

FAIR Health, Inc.

Website

https://fairhealth.org

Company type

Private

Founded year

2009

Operating status

Operating

Headcount range

101–250 employees

Short description

FAIR Health is an independent nonprofit operating the nation's largest private healthcare claims database, licensing benchmark data and cost-estimation tools to 1,500+ payors, providers, government agencies, researchers, life sciences firms, legal entities, and consumers.

Ownership category

akta.pro rank

Product category

Healthcare Claims Data Analytics

NAICS

Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services (5182)

SIC

Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro primary industry

FHIR/HL7 Data Repositories & Canonical Data Models (HLACAIAI)

akta.pro secondary industry

Data Governance, Standards & Interoperability (ICD, HL7/FHIR, LOINC, SNOMED) (HLAJAJAM)

Keywords

• Healthcare claims data
• Medical cost benchmarks
• Fee schedule analytics
• Healthcare price transparency
• Claims benchmarking

Headquarters

HQ city

New York

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Infrastructure, Operations

Revenue model

1. Data Product Licensing: FAIR Health licenses data products including FH Benchmarks, FH Allowed Benchmarks, FH Medicare GapFill PLUS, FH Total Treatment Cost, and FH Online to healthcare stakeholders. Pricing is quote-based for enterprise clients and available through subscription/license agreements. The company serves over 1,500 licensed organizations including health plans, insurers, TPAs, employers, unions, providers, hospitals, government agencies, researchers, and legal entities.
2. Grant-Funded Initiatives: FAIR Health receives grants from foundations including The John A. Hartford Foundation, The New York Community Trust, The Fan Fox & Leslie R. Samuels Foundation, and others to fund specific research initiatives and consumer-facing tool development. These are non-recurring revenue streams tied to specific project deliverables.
3. Consumer Resources: FAIR Health offers free consumer resources (fairhealthconsumer.org, mobile app) which may include opportunities for private-label licensing to organizations wanting to offer branded consumer tools. Organizations can license the consumer website and mobile app under their corporate name and branding.

Pricing tiers

Go-to-market motion2 records

Distribution channels7 records

Marketing channels9 records

Core offering

FAIR Health licenses healthcare cost benchmark data products and provides consumer cost-estimation tools built on the FH NPIC database, the nation's largest private healthcare claims repository with over 54 billion commercial claim records from 75+ contributing health plans. The organization also operates as a CMS-certified Qualified Entity with access to 53+ billion Medicare Parts A, B and D claim records. Products include FH Charge Benchmarks, FH Allowed Benchmarks, FH Total Treatment Cost, FH Medicare GapFill PLUS, FH NSA Reference File, and FH Online query tools, alongside free consumer-facing cost estimators and mobile apps.

Product overview

FAIR Health operates as a platform-plus-modules architecture built around the nation's largest commercial healthcare claims database. The core offering consists of FH® Benchmarks (Charge and Allowed) products—industry-standard claims data resources covering medical, dental, anesthesia, HCPCS, facility, telehealth and urgent care services across 493 geographic regions. These are supplemented by specialized products including FH® Medicare GapFill PLUS for Medicare-based reimbursement, FH® Total Treatment Cost for episode-based pricing, FH® Online query tool, and FH Fee Estimator® for healthcare professionals. Market intelligence is provided through FH® Healthcare Indicators and FH® Medical Price Index reports. The FH NSA Reference File supports federal No Surprises Act compliance. Interactive trackers include Quarterly Telehealth Regional Tracker, Opioid Tracker, and Cost of Giving Birth Tracker. Consumer-facing products include the award-winning FAIR Health Consumer website and FH® Consumer Classroom mobile app (available in English and Spanish), with specialized sub-brands like FAIR Health for Older Adults and FAIR Health Provider. All products leverage the FH NPIC® database of billions of private claims, combined with CMS Medicare data for which FAIR Health holds Qualified Entity certification.

Differentiator

Problem solved

Functional benefit

Products and services

• FH Benchmarks (Charge) Benchmark percentiles based on actual, non-discounted charges as billed by providers, arrayed by CPT, CDT, HCPCS codes and geozip (493 geographic regions). Modules include medical, dental, anesthesia, inpatient facility, outpatient facility, ASC facility, telehealth, and urgent care.
• FH Benchmarks (Allowed) Benchmark percentiles reflecting negotiated in-network allowed amounts, enabling clients to understand in-network payment trends by regional area.
• FH Medicare GapFill PLUS Consolidates all nonfacility CMS fee schedules into a single product and fills gaps for over 1,500 CPT and HCPCS codes for which CMS does not provide a value.
• FH Total Treatment Cost Provides estimates of typical costs for all components of caring for chronic conditions, event-based procedures, and acute conditions, covering beginning-to-end treatment paths including office visits, professional and facility care, testing, equipment, and specialty drugs.
• FH Online Web-based query tool offering convenient, streamlined access to FH Benchmarks data organized by procedure and geographic location for essential business and operations functions.
• FH Fee Estimator for Healthcare Professionals Easy-to-use website providing access to up-to-date benchmarks reflecting non-discounted fees for service as reported by healthcare professionals, available for 36+ medical and dental specialties in 493 geographic areas.
• FH Medical Price Index Tracks growth in median billed charges and median allowed amounts in six medical procedure categories over multiyear periods, critical for stakeholders with financial stakes in the healthcare sector.
• FH Healthcare Indicators Analyzes trends and patterns in healthcare utilization, costs, diagnoses, procedures, and geographic/demographic factors, focusing on growth of alternative places of service.
• FH NSA Reference File Includes median, in-network allowed amounts for medical, HCPCS, anesthesia, outpatient facility and inpatient facility services specifically created to support compliance with the federal No Surprises Act, organized by MSA and Census Division.
• Quarterly Telehealth Regional Tracker Interactive tracker using FAIR Health commercial data to monitor telehealth evolution quarterly, displaying infographics with top procedure categories, telehealth usage rates, and diagnostic categories by age group.
• Opioid Tracker Heat map representing patients with opioid use disorder diagnoses per 100,000 commercially insured patients, with state-level infographics showing top procedure categories and patient demographics.
• Cost of Giving Birth Tracker Interactive heat maps showing state-specific and national median charge and allowed amounts for vaginal deliveries and C-sections including facility and professional costs.
• FAIR Health Consumer Website Free, award-winning consumer website in English and Spanish enabling consumers to estimate medical and dental care costs by procedure and geographic location, with educational curriculum on health insurance.
• FH Consumer Classroom Mobile App Mobile app available from App Store and Google Play offering educational content including FH Insurance Basics, resource links, glossary, healthcare quality toolkit, and interactive puzzles.
• FH NPIC (National Private Insurance Claims) Database Industry-leading collection of privately billed medical and dental procedures from over 75 health plans and third-party administrators, the nation's largest private claims repository with de-identified data from billions of claims.
• FH Custom Analytics Custom data analyses and aggregated datasets created to specifications, including interactive data dashboards and visualizations, leveraging the size and breadth of the FH NPIC database.

Quantifiable outcome

• 57.5% of commercially insured patients had at least one chronic condition in 2024, with costs nearly doubling from $1,590 (no conditions) to $3,039 (one condition)
• +2 more outcomes

Named customers12 records

Segments7 records

Ideal customer profiles6 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Feature6 records

Partnerships

Seven partnerships are on record, tiered core and minor.

• Penn Medicine (Abramson Cancer Center at Pennsylvania Hospital)coreStrategic or Co-development Partner · 1 January 2024One of four Age-Friendly Health Systems collaborating with FAIR Health under The John A. Hartford Foundation-funded initiative. Clinicians are evaluating FAIR Health's shared decision-making tool for early-stage breast cancer with patients.
• The Ohio State University (Wexner Medical Center)coreStrategic or Co-development Partner · 1 January 2024One of four Age-Friendly Health Systems collaborating with FAIR Health. Neuropsychologists at OSU Neuropsychology Clinic are using shared decision-making tools for hip osteoarthritis, dialysis, type 2 diabetes, and Total Treatment Cost tools for Alzheimer's disease.
• Emory University (Division of Geriatrics and Gerontology, Grady Memorial Hospital)coreStrategic or Co-development Partner · 1 January 2024One of four Age-Friendly Health Systems collaborating with FAIR Health. Using shared decision-making tools for primary care and palliative care conditions including hip osteoarthritis, type 2 diabetes, and dialysis.
• University of Rochester Medical Center (Wilmot Cancer Institute)coreStrategic or Co-development Partner · 1 January 2024One of four Age-Friendly Health Systems collaborating with FAIR Health. Using oncology-focused shared decision-making tools including early-stage breast cancer and prostate cancer tools.
• Johns Hopkins University (Hopkins Economics of Alzheimer's Disease & Services Center)coreStrategic or Co-development Partner · 1 January 2023FAIR Health collaborated with Dr. Jevay Grooms of Howard University on a pilot grant from the HEADS Center of the National Institute on Aging to study costs of Alzheimer's disease and related dementias care using FH NPIC database (2016-2023 data).
• Yale School of Public Health (Dr. Chima Ndumele)minorStrategic or Co-development Partner · 1 January 2022Collaborated with Dr. Chima Ndumele, Chair of Health Policy and Management at Yale, to create and disseminate decision aids for conditions pertinent to patients of color (uterine fibroids, type 2 diabetes, slow-growing prostate cancer).
• West HealthcoreStrategic or Co-development Partner · 1 January 2020FAIR Health partnered with West Health to leverage data assets for examining COVID-19 patient comorbidities, risk factors and outcomes. The collaboration included Dr. Marty Makary from Johns Hopkins University and resulted in a November 2020 report on COVID-19 risk factors for privately insured patients.

Scale indicators8 records

Recent moves6 records

Expansion highlights6 records

Broad incumbents

• Optum (UnitedHealth Group): Optum operates one of the largest commercial healthcare claims and analytics platforms in the US, serving payers, providers, employers, and government with integrated data, consulting, and care delivery. It is the most consequential commercial counterpart to FAIR Health's benchmark and analytics business, with overlapping buyer relationships (health plans, TPAs, employers) and a much broader product portfolio spanning RCM, PBM, and clinical analytics.
• Solventum (formerly 3M Health Information Systems): Solventum provides healthcare coding, classification, and reimbursement analytics, including code set standards used by payers and providers (CPT, ICD, DRG). It is a broad incumbent whose code-driven reimbursement analytics and benchmarks overlap with FAIR Health's FH Medicare GapFill and FH Benchmarks products, particularly in payer and provider coding workflows.
• IQVIA: IQVIA is a global life sciences and healthcare analytics company offering commercial claims data, real-world evidence, and benchmarking services to pharma, payers, and providers. It is a broad incumbent with overlapping life sciences, provider, and payer customer relationships and competing benchmark offerings, though at significantly larger scale and with global reach.
• Cotiviti: Cotiviti provides payment accuracy, claims editing, and analytics for health plans and retailers, leveraging proprietary claims data and benchmarks for subrogation and overpayment recovery. It overlaps with FAIR Health's payor analytics use cases (claims adjudication support) and serves many of the same health plan customers.
• Premier Inc. Premier operates a healthcare data and supply chain alliance serving thousands of US hospitals and health systems, including claims-based analytics, benchmarking, and performance improvement services. It is a broad incumbent with overlapping hospital and health system buyer relationships, comparable benchmarking products, and a similar GTM into provider finance and strategy teams.

Direct peers

• Health Catalyst: Health Catalyst is a healthcare data and analytics platform serving health systems, payers, and life sciences with claims and clinical data warehousing, benchmarks, and population health analytics. It overlaps with FAIR Health's data warehousing/analytics positioning and competes for similar health system and payer analytics budgets, though with a more clinical/operational focus.
• Definitive Healthcare: Definitive Healthcare is a commercial provider of healthcare commercial intelligence, including claims-derived analytics, provider and referral data, and benchmarks for the life sciences and provider markets. It competes head-to-head with FAIR Health in selling claims-derived intelligence to payers, providers, life sciences, and consultants, with comparable GTM and similar underlying commercial claims data assets.

Emerging players

• Clarify Health Solutions: Clarify Health provides claims-based analytics and benchmarks for payers, providers, and life sciences, with emphasis on value-based care and provider performance. It is an emerging peer that competes with FAIR Health in the payer/provider analytics segment, with a more AI-native product surface but narrower statutory presence.
• TriNetX: TriNetX operates a global health research network providing real-world evidence from claims and EHR data for life sciences research and clinical trial optimization. It is an emerging peer with comparable claims data monetization model for life sciences and research customers (an explicit FAIR Health segment), though with a research-oriented rather than regulatory benchmark orientation.
• Komodo Health: Komodo Health builds AI-powered longitudinal patient-level claims and EHR analytics for life sciences, payers, and providers, including its Healthcare Map. It is a direct functional competitor to FAIR Health's claims analytics layer, with a more modern AI/ML product surface and venture-scale capital, though it lacks FAIR Health's statutory embedment in state and federal regulations.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/fairhealth
• YouTubeyoutube.com/user/FairHealthInc
• Facebookfacebook.com/fairhealth
• LinkedInlinkedin.com/company/1180854

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 records

Funding overview

Funding rounds2 records

Investors2 records

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about FAIR Health