De-identified claims data

De-identified claims data summarizes medical and pharmacy insurance claims after identifiers have been removed. Pharma, payers, consultancies and health-tech companies use it to size markets, study treatment patterns, estimate costs and see which providers treat which conditions. On DataStoa these listings must be de-identified and, in most cases, aggregated.

Typical fields

• Diagnosis codes (such as ICD-10) and procedure codes (such as CPT or HCPCS)
• Drug codes and days of supply for pharmacy claims
• Service month and care setting
• Allowed or paid amounts, where licensed
• Provider or facility identifiers and coarse geography
• Patient counts and claim counts per cell

Sources and collection

Claims originate with payers, clearinghouses, pharmacy switches and practice-management systems. Providers license these flows, remove direct identifiers and, in the US, either apply the HIPAA Safe Harbor method or obtain an Expert Determination that re-identification risk is very small. Aggregated products then suppress small cells so rare combinations cannot single anyone out.

Delivery and pricing

Usually delivered as aggregated tables or inside secure analytics environments rather than as open files. Pricing is a project fee or annual licence driven by therapeutic scope, years of history, geography and granularity.

Before you buy

• Ask which de-identification method was used and request a summary of the certification.
• Check small-cell suppression thresholds and how they affect rare conditions or small areas.
• Understand the capture rate: which payers, channels and regions are missing.
• Confirm whether amounts are billed, allowed or paid.
• Read restrictions on linking to other data, which many licences prohibit.