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

North Carolina 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

332 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$34.9B

Total Claims

823.1M

Unique Providers

17.0K

Watchlist

2.2K

332 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
99509Home visit day life activity$3.4B62.1M
T2013Habil ed waiver per hour$1.7B11.4M
99214Office o/p est mod 30 min$1.2B19.5M
S5125Attendant care service /15m$1.2B11.6M
T1000Private duty/independent nsg$1.2B2.9M
99199Unlisted special svc px/rprt$942.5M165.4M
T2021Day habil waiver per 15 min$934.8M7.4M
99213Office o/p est low 20 min$917.3M19.5M
99284Emergency dept visit mod mdm$869.1M6.6M
H2022Com wrap-around sv, per diem$716.7M2.5M
View all procedures β†’