Claims Data


Claims Datais the the billable interactions (insurance claims) between insured patients and the healthcare delivery system.

Claims Data falls into four general categories:

  • inpatient
  • outpatient
  • pharmacy
  • enrollment

Claims Data sources can be obtained from the government (e.g., Medicare) and/or commercial health firms (e.g., United HealthCare).

Basic Stand Alone (BSA) Medicare Claims Public Use Files (PUFs)#

This is the Basic Stand Alone (BSA) Public Use Files (PUF) for Medicare claims. This is a claim-level file in which each record is a claim incurred by a 5% sample of Medicare beneficiaries. Claims include inpatient/outpatient care, prescription drugs, DME, SNF, hospice, etc. There are some demographic and claim-related variables provided in every PUF.

Medicaid Statistical Information System#

MSIS is the basic source of state-submitted eligibility and claims data on the Medicaid population, their characteristics, utilization, and payments and is available by clicking on the link on the left-side column.

PharMetrics Integrated Database (IMS Rx Benchmark)#

The PharMetrics Integrated Database is the largest non-Payer owned integrated claims database of commercial insurers in the U.S. This de-identified, Integrated Database includes medical and pharmacy claims for more than 70 million members from more than 100 health plans across the U.S. The Integrated Database includes inpatient and outpatient claims, diagnoses and procedures based on ICD-9 and CPT-4 codes, as well as retail and mail order pharmacy claims.

More Information#

There might be more information for this subject on one of the following: