data set health care claim data set A data set whose members are the specified output of some process of adjudicating health care insurance claims (and whose inputs are at least partly some members of a health care billing data set). Alan Ruttenberg It covers prescription claims because pharmacies bill insurance companies for patients’ prescriptions via submitting insurance claims. Mathias Brocchausen Matthew Diller S. Clint Dowland Sarah Bost The insurance claim is submitted to the insurance company by either the patient or the provider. It is not necessarily always the provider, although in the United States, it typically is. The outcome of the adjudication of a claim in the claims dataset could be favorable or unfavorable for the healthcare provider, the patient, or both. The idea is just that they’ve been adjudicated, one way or the other (or anything in between if that’s a possibility). The reason we say billing data are only part of the input is because we are not conflating the insurance claim with the bill. It is our understanding that the provider’s bill of services is either part of the claim or “attached” to it in some manner, but doesn’t constitute the entire claim itself. The sources of these data are held by insurers or other health plan providers. William R. Hogan healthcare claim data set