FAIR Health Named as Data Source in Connection with Michigan Auto Insurance Law

November 18, 2021

A new Michigan administrative rule has identified FAIR Health as the data source to be used by the Michigan Department of Insurance and Financial Services to review payment determination appeals under the state’s no-fault auto insurance reform legislation.

The no-fault insurance law, Public Acts 21 and 22 of 2019, generally provides for payment based on Medicare. Where no Medicare value is available, the law allows for payment based on a provider’s “charge description master” or the provider’s average charge in effect on January 1, 2019.

Providers may appeal an insurer’s payment determination to the Department of Insurance and Financial Services under Rule 500.65. In the context of an appeal where the provider is unable to supply a “charge description master” or an average charge in effect on January 1, 2019, Michigan Administrative Code Rule 500.205(c) requires the Department to “consult the FAIR Health benchmarking database to determine the average amount charged in the applicable geozip for the service or services at issue…” In accordance with the rule, FAIR Health is providing the Department with average charge amounts for relevant codes in all 12 Michigan geozips from FAIR Health’s most recently published data that include dates of service on January 1, 2019, for use in connection with these appeals. A geozip is a geographic area that typically corresponds with the first three digits of a zip code.

FAIR Health’s engagement in Michigan is the latest case in which FAIR Health data have been incorporated in statutes and regulations around the country. As a testament to their reliability and objectivity, FAIR Health data have been designated as the official, neutral data source for a variety of state health programs, including workers’ compensation and personal injury protection (PIP) programs. FAIR Health data serve as an official reference point in support of certain state balance billing laws that protect consumers against bills for surprise out-of-network and emergency services.

FAIR Health President Robin Gelburd stated: “FAIR Health’s unparalleled data repository and independence make us a valued resource for federal and state government agencies seeking reliable, objective data. We are pleased to be able to support Michigan’s no-fault insurance law.”

For information about the wide range of services and data products FAIR Health offers state health programs and initiatives, contact FAIR Health by email at info@fairhealth.org or call 855-301-3247, Monday through Friday, 9 am to 6 pm ET.