Predict earnings surprises, measure growth across procedures and infusion therapeutics, and track macro utilization trends derived from domestic medical claims. Leo medical claims data is sourced from the largest US healthcare claims clearinghouse.

This dataset contains data for the Healthcare Payments Data (HPD) Snapshot visualization. The Enrollment data file contains counts of claims and encounter data collected for California's statewide HPD Program. It includes counts of enrollment records, service records from medical and pharmacy claims, and the number of individuals represented across these records. Aggregate counts are grouped by payer type (Commercial, Medi-Cal, or Medicare), product type, and year. The Medical data file contains counts of medical procedures from medical claims and encounter data in HPD. Procedures are categorized using claim line procedure codes and grouped by year, type of setting (e.g., outpatient, laboratory, ambulance), and payer type. The Pharmacy data file contains counts of drug prescriptions from pharmacy claims and encounter data in HPD. Prescriptions are categorized by name and drug class using the reported National Drug Code (NDC) and grouped by year, payer type, and whether the drug dispensed is branded or a generic.

Analyze complete patient journeys across both medical and pharmacy claims and accurately track metrics like patient persistence, therapy switches, and concomitant therapies. Medical claims data is sourced from a large health service company with visibility into unblinded provider identities and strong longitudinal integrity allowing for accurate patient journey analytics.

The COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program provides reimbursements on a rolling basis directly to eligible health care entities for claims that are attributed to the testing, treatment, and or vaccine administration of COVID-19 for uninsured individuals. The program funding information is as follow:

TESTING The American Rescue Plan Act (ARP) which provided $4.8 billion to reimburse providers for testing the uninsured; the Families First Coronavirus Response Act (FFCRA) Relief Fund, which includes funds received from the Public Health and Social Services Emergency Fund, as appropriated in the FFCRCA (P.L. 116-127) and the Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139) (PPPHCEA), which each appropriated $1 billion to reimburse health care entities for conducting COVID-19 testing for the uninsured.

TREATMENT & VACCINATION The Provider Relief Fund, which includes funds received from the Public Health and Social Services Emergency Fund, as appropriated in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136), provided $100 billion in relief funds. The PPPHCEA appropriated an additional $75 billion in relief funds and the Coronavirus Response and Relief Supplemental Appropriations (CRRSA) Act (P.L. 116-260) appropriated another $3 billion. Within the Provider Relief Fund, a portion of the funding from these sources will be used to support healthcare-related expenses attributable to the treatment of uninsured individuals with COVID-19 and vaccination of uninsured individuals. To learn more about the program, visit: https://www.hrsa.gov/CovidUninsuredClaim

This dataset represents the list of health care entities who have agreed to the Terms and Conditions and received claims reimbursement for COVID-19 testing of uninsured individuals, vaccine administration and treatment for uninsured individuals with a COVID-19 diagnosis.

For Provider Relief Fund Data - https://data.cdc.gov/Administrative/HHS-Provider-Relief-Fund/kh8y-3es6

Track specialty drug utilization, analyze patient journeys, and predict earnings surprises based on domestic pharmacy claims capturing ~ 90 million patients. Pharmacy claims data is sourced from a large health services company with visibility into commonly blocked specialty pharmacy drugs and strong longitudinal integrity allowing for accurate patient journey analytics.

2016-2019. This dataset is a de-identified summary table of prevalence rates for vision and eye health data indicators from the Medicaid Analytic eXtract (MAX) data. Medicaid MAX are a set of de-identified person-level data files with information on Medicaid eligibility, service utilization, diagnoses, and payments. The MAX data contain a convenience sample of claims processed by Medicaid and Children’s Health Insurance Program (CHIP) fee for service and managed care plans. Not all states are included in MAX in all years, and as of November 2019, 2014 data is the latest available. Prevalence estimates are stratified by all available combinations of age group, gender, and state. Detailed information on VEHSS Medicare analyses can be found on the VEHSS Medicaid MAX webpage (cdc.gov/visionhealth/vehss/data/claims/medicaid.html). Information on available Medicare claims data can be found on the ResDac website (www.resdac.org). The VEHSS Medicaid MAX dataset was last updated May 2023.

Predict earnings surprises, track drug adoption and sales, measure label expansion, and analyze market access based on domestic pharmacy claims. Leo pharmacy claims data is sourced from the largest US healthcare claims clearinghouse.

United States Health Insurance: Claims Per Member Per Month: Medicare data was reported at 1,111.000 USD in 2023. This records an increase from the previous number of 1,012.000 USD for 2022. United States Health Insurance: Claims Per Member Per Month: Medicare data is updated yearly, averaging 791.000 USD from Dec 2007 (Median) to 2023, with 17 observations. The data reached an all-time high of 1,111.000 USD in 2023 and a record low of 746.230 USD in 2007. United States Health Insurance: Claims Per Member Per Month: Medicare data remains active status in CEIC and is reported by National Association of Insurance Commissioners. The data is categorized under Global Database’s United States – Table US.RG022: Health Insurance: Operations by Lines of Business.

The dataset is eligible in exploring Health Insurance fraud Claims using machine learning algorithms. Its well suited for students developimg ML models to predict Healthcare insurance claims fraud.

The Agency for Healthcare Research and Quality (AHRQ) created SyH-DR from eligibility and claims files for Medicare, Medicaid, and commercial insurance plans in calendar year 2016. SyH-DR contains data from a nationally representative sample of insured individuals for the 2016 calendar year. SyH-DR uses synthetic data elements at the claim level to resemble the marginal distribution of the original data elements. SyH-DR person-level data elements are not synthetic, but identifying information is aggregated or masked.

The Health Claims Data Warehouse (HCDW) will receive and analyze health claims data to support management and administrative purposes. The Federal Employee Health Benefits Program (FEHBP) is a $40 billion program covering approximately 8 million eligible participants using more than 100 health insurance carriers. The HCDW will incorporate extensive analytical capabilities to support cost analysis, administration, design, and quality improvement of healthcare services provided to eligible participants.

Marion County is seeking bids for 23P-072 Healthcare Claims Data due 2023-02-23T06:00:00.000Z

This data package contains Medicare spending statistics for beneficiaries grouped according to their age, gender, race/ethnicity and geographical location. At the same time, it provides data about spendings taking into consideration provider specific coordinates like the Hospital Referral Region (HRR) or Hospital Service Area (HSA). The data package contains as well as spending statistics based on the payment system, like the Outpatient Prospective Payment System.

Between 2016 and 2020, registration and/or eligibility was the main reason for **** percent of health insurance claims being denied in the United States. Furthermore, missing or invalid claim data caused over ** percent of health insurance claims to be denied in this time period. This statistic illustrates the leading reasons for denials of healthcare claims in the United States (U.S.) in 2020.

United States Health Insurance: Accident and Health: Net Incurred Claims data was reported at 1,094.702 USD bn in 2023. This records an increase from the previous number of 994.634 USD bn for 2022. United States Health Insurance: Accident and Health: Net Incurred Claims data is updated yearly, averaging 805.750 USD bn from Dec 2015 (Median) to 2023, with 9 observations. The data reached an all-time high of 1,094.702 USD bn in 2023 and a record low of 640.025 USD bn in 2015. United States Health Insurance: Accident and Health: Net Incurred Claims data remains active status in CEIC and is reported by National Association of Insurance Commissioners. The data is categorized under Global Database’s United States – Table US.RG020: Health Insurance: Accident and Health: Net Incurred Claims by Lines of Business.

The medical claims management market, valued at $23.84 billion in 2025, is experiencing robust growth, projected to expand at a Compound Annual Growth Rate (CAGR) of 16.29% from 2025 to 2033. This surge is driven by several key factors. The increasing volume of healthcare data necessitates efficient claims processing systems, fueling demand for advanced software and integrated solutions. A growing emphasis on reducing healthcare costs and improving operational efficiency is further propelling market expansion. The shift towards value-based care models incentivizes providers and payers to optimize claims management for better financial performance. The rising adoption of cloud-based solutions offers scalability and cost-effectiveness, contributing to the market's upward trajectory. Furthermore, advancements in artificial intelligence (AI) and machine learning (ML) are automating various aspects of claims processing, enhancing accuracy and speed. Finally, stringent regulatory compliance requirements across various geographies are also driving investment in sophisticated claims management technologies. Segmentation reveals a diverse market landscape. Integrated solutions are gaining traction over standalone offerings due to their enhanced functionality and streamlined workflows. The software segment commands a larger share compared to services, reflecting the growing preference for automated solutions. Cloud-based delivery models are experiencing rapid adoption, exceeding on-premise solutions in growth rate. Healthcare payers are a major market segment, followed by healthcare providers, reflecting their crucial role in claim submission and reimbursement. North America, particularly the United States, is expected to maintain a significant market share driven by its advanced healthcare infrastructure and high adoption rates of digital technologies. However, other regions like Asia Pacific and Europe are witnessing increasing adoption rates, indicating future growth potential. Key players, including Accenture, Allscripts, Athenahealth, Oracle (Cerner), and McKesson, are actively shaping the market through strategic partnerships, acquisitions, and technological innovations. Recent developments include: In February 2022 Health Edge formed a strategic partnership with Citius Tech for joint go-to-market implementation and consultation services for HealthEdge solutions in Core administration, care management, and payment integrity to health plans pursuing value-based care and streamlined operations. , In December 2021 HealthEdge Software completed its previously announced acquisition of well frame Inc, a leading digital health management platform. . Key drivers for this market are: Government Initiatives Supporting Health Insurance Market, Rising Importance of Denials Management; Growing Aging population with chronic diseases. Potential restraints include: Government Initiatives Supporting Health Insurance Market, Rising Importance of Denials Management; Growing Aging population with chronic diseases. Notable trends are: Cloud-based is Expected to Hold Significant Market Share in Healthcare Claim Management Marke.

CMS Data Feeds includes 119 report feeds, with 25.8B+ rows of data including reporting on claims data dating back to 2007. Updated monthly, this dataset is ideal for tracking healthcare metrics over time, with cleaned and aligned attributes for easy ingestion and comprehensive analysis.

The global healthcare claims processing and management tool market is experiencing robust growth, driven by the increasing need for efficient and accurate claims management within healthcare organizations. The rising adoption of electronic health records (EHRs), coupled with government mandates for interoperability and data exchange, is significantly accelerating market expansion. Furthermore, the increasing volume of healthcare claims, coupled with stringent regulatory requirements, is pushing healthcare providers and payers to adopt sophisticated automated solutions for streamlined processing and reduced administrative burdens. The market is segmented by deployment model (cloud-based and on-premise), functionality (claims submission, adjudication, payment processing), and end-user (providers, payers, and clearinghouses). A competitive landscape exists with both established players and emerging technology companies vying for market share. The projected Compound Annual Growth Rate (CAGR) suggests a substantial increase in market value over the forecast period (2025-2033). While challenges remain, such as high initial investment costs and the need for ongoing system maintenance and updates, the long-term benefits of improved efficiency, reduced operational costs, and enhanced compliance significantly outweigh these hurdles. The market's growth is further fueled by advancements in artificial intelligence (AI) and machine learning (ML) which are being integrated into claims processing solutions to automate complex tasks, improve accuracy, and detect fraudulent claims. Key players are focusing on strategic partnerships and acquisitions to expand their product offerings and geographical reach. The increasing adoption of value-based care models is also impacting the market, necessitating more sophisticated tools capable of handling the complexities of bundled payments and alternative reimbursement mechanisms. Specific regional variations exist based on healthcare infrastructure development, regulatory frameworks, and technological adoption rates. While North America currently holds a dominant market share, other regions, especially in Asia-Pacific and Latin America, are exhibiting considerable growth potential owing to increasing investment in healthcare infrastructure and rising digitalization. This makes the healthcare claims processing and management tools market a dynamic and promising space for innovation and investment.

United States Health Insurance: Accident and Health: Net Incurred Claims: Comprehensive: Individual data was reported at 85.005 USD bn in 2023. This records an increase from the previous number of 70.368 USD bn for 2022. United States Health Insurance: Accident and Health: Net Incurred Claims: Comprehensive: Individual data is updated yearly, averaging 60.222 USD bn from Dec 2015 (Median) to 2023, with 9 observations. The data reached an all-time high of 85.005 USD bn in 2023 and a record low of 55.128 USD bn in 2017. United States Health Insurance: Accident and Health: Net Incurred Claims: Comprehensive: Individual data remains active status in CEIC and is reported by National Association of Insurance Commissioners. The data is categorized under Global Database’s United States – Table US.RG020: Health Insurance: Accident and Health: Net Incurred Claims by Lines of Business.

This dataset is designed to analyze prescription drug use and spending among New York State residents at the drug product level (pharmacy claims data that have been aggregated by labeler code and product code segments of the National Drug Code). The dataset includes the number of prescriptions filled by unique members by payer type, nonproprietary name, labeler name, dosage characteristics, amount insurer paid, and more.