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

Wyoming 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

11 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$902.4M

Total Claims

8.9M

Unique Providers

1.3K

Watchlist

80

11 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$291.0M786.1K
T1015Clinic service$184.7M1.2M
T2022Case management, per month$58.5M222.3K
H2019Ther behav svc, per 15 min$48.7M666.4K
T1004Nsg aide service up to 15min$32.5M421.0K
99213Office o/p est low 20 min$26.3M874.9K
T2024Serv asmnt/care plan waiver$26.0M525.6K
T2031Assist living waiver/diem$23.3M13.1K
99214Office o/p est mod 30 min$21.0M555.4K
D1206Topical fluoride varnish$19.6M561.1K
View all procedures β†’