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

Nevada 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

150 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$8.1B

Total Claims

172.2M

Unique Providers

9.0K

Watchlist

809

150 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
T1019Personal care ser per 15 min$752.3M9.3M
T2017Habil res waiver 15 min$695.3M325.5K
T1017Targeted case management$335.8M2.3M
99214Office o/p est mod 30 min$311.8M4.9M
99213Office o/p est low 20 min$269.0M5.8M
99285Emergency dept visit hi mdm$241.3M2.1M
T1015Clinic service$231.2M715.8K
90999Unlisted dialysis procedure$180.3M2.8M
99284Emergency dept visit mod mdm$176.1M2.0M
A0427Als1-emergency$171.3M572.1K
View all procedures β†’