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National Information Center on Health Services Research and Health Care Technology (NICHSR)

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Payer records are limited in important respects. They
  • Only cover individuals whose care is paid from the source.
  • Do not offer a comprehensive view because they leave out people who are not covered by the payer's records.
  • Depend on the coding of procedures and diagnoses used by claimants who may be motivated by billing considerations which could shape the information provided
  • Provide only a partial view of health care service for any group depending on the terms and conditions of the health insurance coverage which may exclude certain kinds of care or limit coverage of certain conditions.

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