Healthcare Transparency, Powered by Public Data
Powered by Official HHS Open Data · Jan 2018 – Dec 2024 · All 50 States
Medicaid Score analyzes 227 million+ Medicaid claims records across 617,000+ providers to surface unusual billing patterns — so you can see what the data reveals.
Launching Spring 2026 · Early members receive priority access
Austin, TX · Applied Behavior Analysis
Medicaid Score™
Key Signals
Example Insight
This provider’s billing volume for procedure 97153 is 3.2× the Texas state median over the past 12 months.
Billing trend 2018 – 2024
227M+
Claims Analyzed
617K+
Providers
7 Years
of Data
50
States
Built for anyone who wants clearer insight into public healthcare spending.
Look up your provider’s billing patterns before making care decisions.
Find data-backed leads on unusual Medicaid billing in any state or specialty.
Access structured, peer-adjusted Medicaid billing data across 7 years and 50 states.
Benchmark your own billing patterns against peers in your state and specialty.
From raw federal data to a clear, actionable score in four steps.
Every provider-level Medicaid billing record published by CMS — 227 million claims across 7 years.
Each NPI is matched against the federal NPPES registry to identify provider name, location, and specialty.
An ABA clinic is compared to other ABA clinics in the same state — not to hospitals, pharmacies, or general practitioners.
A 0–100 Medicaid Score™ with confidence level and the specific billing patterns that drive it.
Data is monitored continuously as new CMS releases are published.
Search any provider. Compare scores across your state. Drill into the billing patterns that drive each score.
Coming Spring 2026
Providers Indexed
617,503
Avg. Score
34
Elevated or Higher
18.2%
Last Updated
Feb 2026
Acme Behavioral Health Services
NPI: 1234567890
Sunrise Pediatric Therapy
NPI: 9876543210
Pinnacle Home Health LLC
NPI: 5551234567
Carebridge Counseling Group
NPI: 3216549870
Valley Speech & Language Center
NPI: 7778889990
The CMS Medicaid Provider Spending dataset contains one row for every provider × procedure × month combination. Here’s what each record includes:
| Field | What It Tells Us |
|---|---|
| Billing Provider NPI | Who submitted the claim |
| Servicing Provider NPI | Who performed the service |
| Procedure Code (HCPCS) | What service was provided |
| Claim Month | When the service occurred |
| Unique Beneficiaries | How many patients were served |
| Total Claims | How many claims were submitted |
| Total Paid | How much Medicaid paid |
Provider names, addresses, and specialties are resolved from the federal NPPES NPI Registry. Records with fewer than 12 claims are suppressed by CMS for privacy.
The federal government publishes detailed Medicaid billing data for every provider in the country. But 227 million rows of procedure codes don’t mean much without context. Medicaid Score turns raw billing records into clear, peer-adjusted signals — so unusual patterns don’t go unnoticed.
Our scoring methodology uses peer-group clustering, statistical z-scores, and billing concentration analysis. We compare each provider only to similar providers in the same state and specialty.
MedicaidScore does not make accusations. It surfaces statistical patterns in context.
Scores reflect statistical patterns in aggregated billing data published by the Centers for Medicare & Medicaid Services and do not imply fraud, misconduct, or poor quality of care. They do not constitute medical, legal, or financial advice.
Get alerts when providers in your area show unusual shifts in billing patterns. Early members receive priority access at launch.
Early members receive priority access at launch.
I’m a:
Launching Spring 2026 · No spam, ever.