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 Mexico 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

237 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$13.7B

Total Claims

169.9M

Unique Providers

4.2K

Watchlist

838

237 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$1.3B4.3M
T1019Personal care ser per 15 min$1.2B16.9M
T2016Habil res waiver per diem$883.7M2.5M
99213Office o/p est low 20 min$487.0M5.8M
99214Office o/p est mod 30 min$472.9M5.3M
T2033Res, nos waiver per diem$421.6M1.5M
90837Psytx w pt 60 minutes$334.2M2.8M
99284Emergency dept visit mod mdm$299.0M1.9M
H2021Com wrap-around sv, 15 min$270.7M786.1K
99285Emergency dept visit hi mdm$248.0M1.2M
View all procedures β†’