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 Hampshire 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

57 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$6.0B

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ $856.4M / year

Total Claims

60.5M

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ 8.6M / year

Unique Providers

2.1K

Distinct billing NPIs, Jan 2018 – Dec 2024

Watchlist

181

57 highest/critical risk

Current (as of latest ETL)

Monthly Spending Trend
Top 10 Providers by Spending
View all providers β†’
Spending by Category
Top 10 Procedures by Spending
CodeDescriptionTotal PaidClaims
T1020Personal care ser per diem$1.3B4.0M
T2021Day habil waiver per 15 min$493.9M2.9M
T1016Case management$413.2M2.5M
T2025Waiver service, nos$373.9M327.3K
T1019Personal care ser per 15 min$280.9M2.0M
H0019Behavioral health; long-term residential (non-medical, non-acute care in a$229.8M164.5K
S5140Adult foster care per diem$177.8M378.5K
T1015Clinic service$159.4M936.0K
H2019Ther behav svc, per 15 min$145.8M1.6M
E0766Electrical stimulation device used for cancer treatment, includes all$112.8M14.7K
View all procedures β†’