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

New Jersey 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

474 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$47.0B

Total Claims

784.5M

Unique Providers

16.1K

Watchlist

2.0K

474 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
H2016Comp comm supp svc, per diem$8.7B17.7M
T1019Personal care ser per 15 min$4.2B47.4M
S5102Adult day care per diem$2.1B25.5M
T2021Day habil waiver per 15 min$1.7B9.8M
T1018School-based iep ser bundled$1.6B13.7M
99284Emergency dept visit mod mdm$1.3B5.6M
99213Office o/p est low 20 min$1.1B23.8M
99283Emergency dept visit low mdm$1.1B4.8M
T2023Targeted case mgmt per month$997.4M1.2M
99214Office o/p est mod 30 min$840.5M13.1M
View all procedures β†’