Medical Claims Data

Definition - What does Medical Claims Data mean?

Medical claims data is information found in medical billing claims forms filed on behalf of a group or population. This information is gathered from the medical bills or claims submitted by medical providers to government and private health insurers. The information obtained from medical claims can be used to evaluate the delivery and cost of healthcare as part of evidence-based public health programs. Medical claims data is sometimes called health claims data.

WorkplaceTesting explains Medical Claims Data

Most medical providers' billing methods use uniform, predefined codes identifying the health care services provided. This consistency in the categorization of health care services across multiple providers allows the information to be easily collected and compared. Before medical claims data may be used for research or analysis, personally identifiable information is removed through a de-identification process. This process protects the individual patient's privacy. The "anonymized" data can then be sorted using variables such as patient age, gender, diagnosis, or other factors. The ability to access such a large amount of information about the health of a population aids researchers, public policy makers, and healthcare administrators in evaluating the entire healthcare system.

In the workplace, medical claims data may be sorted by demographics at either the individual or organizational level. For instance, health care claims can be grouped by the age or education level of a group of employees or classified by worksite or task. This information can then be evaluated, and the results used to implement better-targeted workplace safety and wellness activities. By identifying the most costly, or most common, types of health claims within a workforce population, an employer can employ wellness program resources to reduce those claims. The information gathered from medical claims data may also be used to identify hidden risk factors at a particular job site or within a workgroup.

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