Concourse Sentinel

Medicaid Integrity Analytics

πŸ“ŠOverviewπŸ₯ProvidersπŸ’ŠProcedures🚨WatchlistπŸ”Statistical Outliersβš–οΈCompareπŸ“ˆTrendsπŸ—ΊοΈGeography

Cross-Dataset

πŸ•ΈοΈEntity Networks🏠Home Healthβ›”Exclusions (LEIE)πŸ“‹Context & Disclaimers
πŸ‡ΊπŸ‡ΈAll States
by Concourse

Data: CMS T-MSIS 2018-2024

Source: opendata.hhs.gov

Colorado Medicaid Provider Spending

CMS T-MSIS data, 2018-2024

Concourse Sentinel connects to large-scale healthcare billing datasets β€” including CMS T-MSIS claims, provider enrollment (PECOS), and federal exclusion lists β€” and runs millions of automated statistical analyses to surface billing anomalies and areas warranting further review.

Cross-Dataset Analysis Available

Watchlist

412 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$21.6B

Total Claims

342.4M

Unique Providers

12.3K

Watchlist

1.8K

412 highest/critical risk

Monthly Spending Trend
Top 10 Providers by Spending
View all providers β†’
Spending by Category
Top 10 Procedures by Spending
CodeDescriptionTotal PaidClaims
T2016Habil res waiver per diem$2.4B8.2M
T1019Personal care ser per 15 min$1.7B10.7M
A0100Nonemergency transport taxi$1.3B38.9M
H0038Self-help/peer svc per 15min$1.3B6.2M
99213Office o/p est low 20 min$896.3M9.4M
99214Office o/p est mod 30 min$716.4M8.0M
A0130Noner transport wheelch van$664.5M14.1M
T2021Day habil waiver per 15 min$658.5M4.0M
S5130Homaker service nos per 15m$406.2M4.9M
90837Psytx w pt 60 minutes$386.2M3.8M
View all procedures β†’