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

Missouri 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

290 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$28.0B

Total Claims

346.1M

Unique Providers

15.7K

Watchlist

1.8K

290 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
T1019Personal care ser per 15 min$6.2B74.3M
T2016Habil res waiver per diem$5.2B11.6M
T1040Comm bh clinic svc per diem$3.9B15.0M
T2021Day habil waiver per 15 min$905.0M4.9M
A0100Nonemergency transport taxi$866.2M39.8M
G9012Other specified case mgmt$645.0M10.2M
99213Office o/p est low 20 min$479.9M8.5M
99214Office o/p est mod 30 min$407.6M6.0M
X4011Code X4011$345.4M1.0M
T1000Private duty/independent nsg$338.9M1.1M
View all procedures β†’