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 Dakota 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

34 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$2.2B

Total Claims

18.6M

Unique Providers

1.2K

Watchlist

172

34 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$408.0M1.0M
W0725Code W0725$247.8M98.3K
T2021Day habil waiver per 15 min$172.5M1.0M
99213Office o/p est low 20 min$104.5M1.1M
W0715Code W0715$96.0M212.6K
99214Office o/p est mod 30 min$72.0M727.9K
W0300Code W0300$51.6M82.4K
S5125Attendant care service /15m$48.1M269.6K
99284Emergency dept visit mod mdm$47.4M270.9K
99283Emergency dept visit low mdm$39.8M261.4K
View all procedures β†’