What it is
ClaimLight reports what physicians and other practitioners bill to Original Medicare Part B, by specialty, metro area, state, group, hospital, city, provider and billing code. The main measures are services, beneficiaries, Medicare payment and fee-for-service work RVUs, each shown in a report with its data year and with where it sits among peers of the same specialty in the same area. A market report adds density per 10,000 Medicare beneficiaries, the distribution and five-year trends. Every formula is on the methodology page.
Turn complex CMS data into a clear physician or market report. The CMS files are public. ClaimLight organizes them, performs the calculations described on the methodology page and presents the results for one physician or one market. Methodology, sources and definitions are free; a report pays for that preparation, analysis, presentation and access. Search, each physician's identity and location, the data years available, coverage limits and a sample report are free; see Pricing for the Physician Report and the Market Comparison.
Sources
Every figure on the site comes from these inputs:
- Medicare Physician & Other Practitioners, by Provider and Service, and by Provider, Centers for Medicare & Medicaid Services (CMS), data.cms.gov: services, beneficiaries, submitted charges, allowed amounts, payments and standardized payments per provider and billing code, and the reported provider totals.
- Doctors and Clinicians National Downloadable File and Facility Affiliation file, CMS Provider Data Catalog: group and hospital affiliations, with the snapshot date shown on each organization page.
- Hospital General Information, CMS Provider Data Catalog: hospital names and locations.
- Medicare Monthly Enrollment, CMS, data.cms.gov: Original Medicare and Medicare Advantage enrollment by county, behind beneficiary density and the county Original Medicare share default in the offer calculator.
- USPS ZIP Code Crosswalk Files (ZIP to county, ZIP to CBSA), U.S. Department of Housing and Urban Development, Office of Policy Development and Research: assigning each practice ZIP code to a county and a metro area.
- Core Based Statistical Area delineation files, U.S. Census Bureau: metro area names and boundaries.
- Physician Fee Schedule Relative Value Files (PPRRVU), CMS: the work RVU of each billing code for the matching service year.
- Published payer-mix figures: National Ambulatory Medical Care Survey (2014 to 2016) and National Hospital Ambulatory Medical Care Survey, emergency departments (2022), National Center for Health Statistics (NCHS), CDC: the default Medicare share of each specialty's work in the offer calculator and the aggregate estimates; each default shows its source where it is used.
- NPI Registry, CMS National Plan and Provider Enumeration System (NPPES): checking an NPI and last name when someone verifies their NPI or claims a page; nothing from it is displayed.
Work RVU totals, percentiles, rank bands, peer cohorts, organization medians, market statistics and every figure labeled estimated or scenario are computed by ClaimLight from these inputs, with the formulas on the methodology page. They are ClaimLight's calculations, not figures published by CMS or any other agency.
Insurer price transparency files are not a source for anything on the site. No patient-level data is used.
What it is not
- Not all of a provider's work. Medicare Advantage, Medicaid, commercial insurance and self-pay patients are not in these files.
- Not what anyone is paid. Medicare pays the billing entity, which may be a group or hospital rather than the clinician, and employed clinicians are paid under their own contracts.
- Not a judgement about any provider. The site reports counts, totals and where values fall in a distribution; it does not characterize anyone's practice or care. High or low values often reflect specialty focus, referral patterns or practice setting.
- Not an observed figure where a number is labeled "estimated" or "scenario". Estimates use stated assumptions and appear only for specialties and areas, never for a named provider or organization.
- Not for employment, credentialing, insurance, tenant or credit decisions; the Terms do not allow those uses.
Known limitations are listed in full on the methodology page.
Who owns and runs it
ClaimLight is owned and operated by Pacific Clinical Solutions LLC. Pacific Clinical Solutions is owned by a practicing physician with Hawai‘i infectious disease practice affiliations; the product lead is Ben Thomas, MD, MSCI. Because the owner's own specialty and state are in the data, every provider is computed by the same method, the owner's page and his partners' pages get no special handling, and correction requests about them or any other Hawai‘i infectious disease physician are decided strictly by the written rules, with the reasoning recorded.
Contact: ben@claimlight.io. Corrections: the corrections form or corrections@claimlight.io. Physicians can claim their page for notices and a statement; a claim shows no figures.
Not affiliated with or endorsed by the Centers for Medicare & Medicaid Services or the U.S. Department of Health and Human Services.