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

Montana 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

42 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$5.4B

Total Claims

74.9M

Unique Providers

3.4K

Watchlist

249

42 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
S5126Attendant care service /diem$1.8B18.1M
T1019Personal care ser per 15 min$553.0M4.1M
T2017Habil res waiver 15 min$276.9M55.7K
S5150Unskilled respite care /15m$234.0M3.1M
90837Psytx w pt 60 minutes$172.4M2.2M
H0036Comm psy face-face per 15min$147.1M1.7M
99214Office o/p est mod 30 min$120.1M1.7M
T2021Day habil waiver per 15 min$118.1M116.7K
99213Office o/p est low 20 min$103.0M2.3M
S5145Child fostercare th per diem$98.5M429.9K
View all procedures β†’