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.

Legacy management information system for Title XVI initial claims.

Read reports on priority public health topics including opioid, stimulant, & other substance use, maternal & child health, and racial & health inequities

This dataset contains measures that evaluate the quality of care delivered by Health Homes for the Centers for Medicare & Medicaid Services (CMS) Core Set and Health Home State Plan Amendment (SPA). To support ongoing assessment of the effectiveness of the Health Home model, the CMS has established a recommended Core Set of health care quality measures that it intends to promulgate in the rulemaking process. The data used in the Health Home Quality Measures are taken from the following sources: • Medicaid Data Mart: Claims and encounters data generated from the Medicaid Data Warehouse (MDW). • QARR Member Level Files: Sample of the health plan eligible member’s quality. • New York State Delivery System Inform Incentive Program (DSRIP) Data Warehouse: Claims and encounters data generated from the Medicaid Data Warehouse (MDW).

Please refer to the Overview document for additional information.

Current store for information on initial claims from submission to adjudication in title 16.

Global big data analytics in healthcare market is expected to generate revenue of around $145.03 billion by 2032, growing at a CAGR of around 15.96%.

Ever wonder how many claims or people are in the Colorado All Payer Claims Database (CO APCD), and how it differs by type of claim (medical, dental, pharmacy), by year and by payer type? Use this interactive dashboard to understand what the CO APCD includes and what percentage of the population is represented in each county. Additional information is also available on race and ethnicity data, behavioral health services, dental code volume, and vision claims that are in the data warehouse under the Resources link.

This UMB dataset available from the Centers for Medicare and Medicaid Services (CMS) Chronic Condition Data Warehouse (CCW) consists of a 5% random sample of all Medicare and Medicaid beneficiaries with claims and assessment data linked across the continuum of care with matching, deduplications, and merging of files already processed. The CMS CCW includes variables for 27 chronic conditions which identify additional chronic health, mental health and substance abuse issues. Developed to facilitate researchers in the identification of cohorts of beneficiaries with specific conditions, the variables are the result of algorithms that searched the CMS administrative claims data for specific diagnosis, MS-DRG, and procedure codes. It is maintained by the Pharmaceutical Research Computing Center within the Department of Pharmaceutical Health Services Research at the University of Maryland School of Pharmacy. The Center provides computer programming, data management, pharmaceutical classification, and analytical support for health services research and evaluation.

description:

The Home Health Agency PUF contains information on utilization, payment (Medicare payment and standard payment), and submitted charges organized by CMS Certification Number (6-digit provider identification number), Home Health Resource Group (HHRG), and state of service. This PUF is based on information from CMSs Chronic Conditions Data Warehouse (CCW) data files. The data in the Home Health Agency PUF covers calendar year 2013 and contains 100 percent final-action (i.e., all claim adjustments have been resolved) home health agency institutional claims for the Medicare fee-for-service (FFS) population.

The Home Health Agency PUF contains information on utilization, payment (Medicare payment and standard payment), and submitted charges organized by CMS Certification Number (6-digit provider identification number), Home Health Resource Group (HHRG), and state of service. This PUF is based on information from CMSs Chronic Conditions Data Warehouse (CCW) data files. The data in the Home Health Agency PUF covers calendar year 2013 and contains 100 percent final-action (i.e., all claim adjustments have been resolved) home health agency institutional claims for the Medicare fee-for-service (FFS) population.

Purpose: Develop an easy-to-use data product to facilitate comparative effectiveness research involving complex patients. Scope: Claims data can be difficult to use, requiring experience to most appropriately aggregate to the patient level and to create meaningful variables such as treatments, covariates, and endpoints. Easy to use data products will accelerate meaningful comparative effectiveness research (CER). Methods: This project used data from the Medicare Chronic Condition Data Warehouse for patients hospitalized with acute myocardial infarction (AMI) or stroke in 2007 with two-year follow-up and one-year pre-admission baseline. The project joined over 100 raw data files per condition to create research-ready person- and service-level analytic files, code templates, and macros while at the same time adding uniformity in measures of comorbid conditions and other covariates. The data product was tested in a project on statin effectiveness in older patients with multiple comorbidities. Results: A programmer/analyst with no administrative claims data experience was able to use the data product to create an analytic dataset with minimal support aside from the documentation provided. Analytic dataset creation used the conditions, procedures, and timeline macros provided. The data structure created for AMI adapted successfully for stroke. Complexity increased and statin treatment decreased with age. The two-year survival benefit of statins post-AMI increased with age. Conclusion: Claims data can be made more user-friendly for CER research on complex conditions. The data product should be expanded by refreshing the cohort and increasing follow-up. Action is warranted to increase the rate of statin use among the oldest patients. Data Access: These data are not available from ICPSR. The data cannot be made publicly available. Data are stored on University of Iowa College of Public Health secure servers, and may be used only for projects covered within the aims of the original research protocol and Centers for Medicare and Medicaid Services (CMS)-approved data use agreement. Data sharing is allowed only for research protocols approved under data re-use requests by the CMS privacy board. The CMS process for data re-use requests is described at Research Data Assistance Center (ResDac). Please note that as of May 2013, the DUA covering this work is set to expire February 1, 2014. Thereafter, per the terms of the DUA, datasets created for this project may not be available. User guides are available from ICPSR for detailed descriptions of the data products, including a user guide for Acute Myocardial Infarction (AMI) Analytic Files and a user guide for Stroke and Transient Ischemic Attack (TIA) Analytic Files. Data dictionaries are available upon request. Please contact Nick Rudzianski (nicholas-rudzianski@uiowa.edu or 319-335-9783) for more information.

This data store contains detailed initial claims data that will provide summarized workload and respective task information for both Title II and Title XVI claims, at the office, regional and national levels.

The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2014 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

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Insurance Third Party Administrators Market Size 2025-2029

The insurance third party administrators market size is forecast to increase by USD 136.5 billion at a CAGR of 7.3% between 2024 and 2029.

The Insurance Third Party Administrators (TPA) market experiences robust growth, driven by the increasing demand for specialized services in the insurance industry. As businesses seek to streamline operations and improve efficiency, the outsourcing of administrative functions to TPAs becomes an attractive option. Technological advancements further fuel market expansion, enabling TPAs to offer advanced services such as digital claims processing and data analytics. However, market growth is not without challenges. Regulatory hurdles impact adoption, with stringent regulations governing data privacy and security, requiring TPAs to invest significantly in compliance measures.
Supply chain inconsistencies also temper growth potential, as TPAs rely on various stakeholders, including insurance companies, healthcare providers, and claims adjusters, to deliver services effectively. Despite these challenges, the market presents significant opportunities for companies that can navigate these complexities and provide innovative solutions to meet the evolving needs of the insurance industry.

What will be the Size of the Insurance Third Party Administrators Market during the forecast period?

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Understanding the Dynamics and Trends in the US Third-Party Administration Market The third-party administration (TPA) market in the US is experiencing significant growth and innovation, driven by the increasing demand for efficient and effective management of employee benefits and insurance programs. TPA services encompass various functions, including utilization management, performance measurement, change management, and fraud detection in life insurance, group health plans, and government programs. Customer experience is a top priority, with machine learning and predictive modeling enabling personalized services and real-time analytics. Data governance and interoperability are essential for ensuring data security and accuracy in data warehousing and API integration.
Ethical practices and industry consortiums promote social responsibility and transparency. TPA companies invest in innovation hubs, agile development, and mobile applications to streamline policy administration and claims processing. Compliance consulting and risk modeling help organizations navigate complex regulatory requirements. Wellness programs and provider contracting are crucial components of managed care, while network management and medical billing optimize costs and improve financial reporting. Security audits, disaster recovery, business continuity, and project management ensure business resilience, while data visualization and business intelligence tools enhance customer satisfaction. Long-term care and compliance consulting further expand the scope of TPA services.

How is this Insurance Third Party Administrators Industry segmented?

The insurance third party administrators industry research report provides comprehensive data (region-wise segment analysis), with forecasts and estimates in 'USD billion' for the period 2025-2029, as well as historical data from 2019-2023 for the following segments.

Service Type

  Health plan administrators
  Workers compensation TPA
  Third party claims administration


Type

  Large enterprises
  Small and medium enterprise


Service

  Claims management
  Policy management
  Commission management


Application

  Healthcare
  Construction
  Real estate
  Hospitality
  Others


Geography

  North America

    US
    Canada
    Mexico


  Europe

    France
    Germany
    Italy
    Spain
    The Netherlands
    UK


  Middle East and Africa

    UAE


  APAC

    China
    India
    Japan
    South Korea


  South America

    Brazil


  Rest of World (ROW)

By Service Type Insights

The health plan administrators segment is estimated to witness significant growth during the forecast period.

Health plan administrators, including those serving Large Enterprise Insurance and Health Insurance, play a pivotal role in the healthcare ecosystem by managing various administrative tasks related to health insurance plans on behalf of employers, insurance companies, or self-insured organizations. Their primary responsibilities include claim processing, enrollment and eligibility management, and premium billing and management. The integration of technology is significantly impacting the operations of health plan administrators. For instance, Cloud Computing facilitates data accessibility and storage, enabling real-time data processing and analysis. Data Security ensures the confidentiality and integrity of sensitive health information. Digital Transformation, including Workflow Automation and Process Effic

The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2014 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

Splitgraph serves as an HTTP API that lets you run SQL queries directly on this data to power Web applications. For example:

See the Splitgraph documentation for more information.

This dataset contains measures of Health Home member service utilization. The New York State Department of Health (NYSDOH) collects annual data on children’s and adults’ use of health services. This information complements the Health Home Quality Measures information collected for the State Plan Amendment (SPA) and Core Set of health care quality measures. Utilization measures are designed to capture the frequency of certain services. NCQA does not view higher or lower services counts as better or worse performance.

The data used in the Health Home Utilization Measures are taken from the following sources: • Medicaid Data Mart: Claims and encounters data generated from the Medicaid Data Warehouse (MDW).

Please refer to the Overview document for additional information.

The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2014 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2014 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

Content

The hospital readmission rate PUF presents nation-wide information about inpatient hospital stays that occurred within 30 days of a previous inpatient hospital stay (readmissions) for Medicare fee-for-service beneficiaries. The readmission rate equals the number of inpatient hospital stays classified as readmissions divided by the number of index stays for a given month. Index stays include all inpatient hospital stays except those where the primary diagnosis was cancer treatment or rehabilitation. Readmissions include stays where a beneficiary was admitted as an inpatient within 30 days of the discharge date following a previous index stay, except cases where a stay is considered always planned or potentially planned. Planned readmissions include admissions for organ transplant surgery, maintenance chemotherapy/immunotherapy, and rehabilitation.

This dataset has several limitations. Readmissions rates are unadjusted for age, health status or other factors. In addition, this dataset reports data for some months where claims are not yet final. Data published for the most recent six months is preliminary and subject to change. Final data will be published as they become available, although the difference between preliminary and final readmission rates for a given month is likely to be less than 0.1 percentage point.

Data Source: The primary data source for these data is the CMS Chronic Condition Data Warehouse (CCW), a database with 100% of Medicare enrollment and fee-for-service claims data. For complete information regarding data in the CCW, visit http://ccwdata.org/index.php. Study Population: Medicare fee-for-service beneficiaries with inpatient hospital stays.

Context

This is a dataset hosted by the Centers for Medicare & Medicaid Services (CMS). The organization has an open data platform found here and they update their information according the amount of data that is brought in. Explore CMS's Data using Kaggle and all of the data sources available through the CMS organization page!

• Update Frequency: This dataset is updated daily.

Acknowledgements

This dataset is maintained using Socrata's API and Kaggle's API. Socrata has assisted countless organizations with hosting their open data and has been an integral part of the process of bringing more data to the public.

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This dataset is distributed under NA

The dataset contains information on average utilization and payments (submitted charges, Medicare allowed amount, Medicare Payment amount, Medicare standardized payment amount) on Healthcare Common Procedure Coding System (HCPCS) codes on the state level. This Public Use File is based on information from Centers for Medicare and Medicaid Services administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse.

The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2014 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.