Claims Data Access Levels
| Access Level | Data Provided | Value |
|---|---|---|
| Full access | Complete de-identified claims data; member-level detail | Highest — enables full population health analytics |
| Summary access | Aggregate claims data by condition, provider, and service | Medium — enables cost driver analysis |
| Limited access | High-level summary reports only | Low — limited analytical value |
| No access | No claims data provided | None — equivalent to fully insured |
Using Claims Data
Full claims data access enables: (1) population health analytics — identify the top cost drivers and high-risk members; (2) program design — design programs that address the specific health needs of your population; (3) vendor evaluation — measure the impact of wellbeing and disease management programs; and (4) renewal preparation — use claims data to support renewal negotiations.
Data Privacy
Compliance Note
Claims data must be de-identified to protect employee privacy. The employer should receive aggregate, de-identified reports — not individual-level data. HIPAA prohibits using PHI for employment purposes. Confirm your level-funded carrier provides de-identified data and has a HIPAA business associate agreement.