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

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ $6.7B / year

Total Claims

784.5M

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ 112.1M / year

Unique Providers

16.1K

Distinct billing NPIs, Jan 2018 – Dec 2024

Watchlist

2.0K

474 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
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†’