Sentinel is the managed-care program integrity analytics layer that complements your existing scope. Built to sub under federal review primes, MMIS primes, CMS analytics primes, MFCU support primes, and major consulting primes holding state Medicaid engagements.
Medicaid MCO denial pattern intelligence to complement Medicare program integrity scopes with state-side evidence.
Federal review primesPlug-in managed-care program integrity analytics layer that extends your existing scope and reduces analytic burden.
Fiscal-agent primesEvidence-ready workpapers for state Medicaid accountability engagements, audit support, and IG response work.
Major consultingState-IG-audit-grounded vector library that turns federal data into state-level operational findings.
Data-platform primesEvidence-tier-matched audit packets ready for AG civil action and AG/MFCU criminal referral with chain-of-custody preservation.
Investigative primesThe PI dimension EQRO scopes typically underweight: MCO SIU referral scorecards, encounter completeness, federally-validated denial analysis.
Quality review primesMACPAC and HHS-OIG have documented the same gap for five years. Sentinel is the analytics layer that closes it.
Federal and state oversight reports keep documenting the same structural finding. 10 percent of Medicaid managed care plans made zero fraud referrals in 2022, covering 1.6 million enrollees and 8 billion dollars in capitation across 13 states. UPIC contractors conduct minimal managed-care PI work. State OIGs hold statutory access to MCO data but rarely have action-ready workflow in place.
Most enterprise PI primes are built for MCOs as customers, not for state oversight of MCOs. That structural alignment is hard to reposition mid-contract. Sentinel fills the gap as a focused subcontract layer, with the federal-evidence corpus and the state-IG-audit grounding that primes typically do not maintain in-house.
We complement. We never compete with your existing scope.
Where Sentinel adds the managed-care program integrity analytics layer your platform does not currently field
UPIC primes, RAC primes, SMRC primes, MEDIC primes, and HHS-OIG support contractors who hold CMS contract vehicles covering Medicare and Medicaid program integrity.
What Sentinel adds: the state managed-care PI analytics layer the 2022 HHS-OIG report on UPICs identified as a documented gap. LCD-vs-MCO-denial validation. Encounter completeness scoring. SIU referral underperformance scorecards.
Federal analytics primes holding CMS data-infrastructure contracts (One PI, IDR, MACBIS, T-MSIS analytics support, federal-health analytics blanket purchase agreements).
What Sentinel adds: the state-IG-audit-grounded vector library and the cross-program use-case logic that turns federal data into state-level operational findings. Sentinel rides on the prime's data substrate, never competing with it.
Primes holding state Medicaid Enterprise System contracts, fiscal-agent contracts, and KMMS/TIERS-class eligibility infrastructure.
What Sentinel adds: the independent program integrity intelligence layer that sits above the prime's claims and encounter pipeline. State OIGs and AG offices increasingly require independence between the system operator and the program integrity analytics. Sentinel provides that independence as a sub.
Primes supporting state Attorney General Medicaid Fraud Control Units with case management, investigative services, and recovery operations.
What Sentinel adds: evidence-tier-matched audit packets ready for AG civil action and AG/MFCU criminal referral, with chain-of-custody preservation and federal-validation grounding on every finding. Sentinel feeds your investigators with action-ready evidence, not raw alerts.
Major consulting primes holding state Medicaid implementation, modernization, eligibility-systems, and program-integrity-advisory engagements.
What Sentinel adds: the specialist Medicaid PI vector library and federal-evidence corpus that consulting primes do not maintain in-house. Sentinel slots in as the named PI analytics partner, with white-label or co-branded delivery options.
External Quality Review Organizations and federally-designated quality-review primes serving state Medicaid managed care under 42 CFR Part 438.
What Sentinel adds: the PI dimension that EQRO scopes typically underweight. MCO SIU referral scorecards, encounter completeness, and federally-validated denial analysis become measurable EQRO findings rather than narrative observations.
Six reasons primes choose Sentinel for the managed-care PI lane
Sentinel never sells to MCOs as customers. Our entire architecture is oriented toward state and federal oversight bodies that audit MCOs. That posture is hard to reposition mid-contract and is exactly what state agencies require from PI analytics.
207,638 LCDs and NCDs, 98,186 ICD-10-CM codes, 8,962+ verified provider NPIs, and 35M+ PubMed clinical articles integrated. Every finding is federally validated, not statistical. Defensible at every evidentiary tier.
36 fraud detection vectors mapped finding-by-finding to 20 published state IG audit findings. 34 use cases scored across lawmaker emphasis, headline heat, and documented fraud exposure. Tiered for procurement, demo, and roadmap conversations.
National evidence base is pre-loaded. State regulatory overlay is built per state in weeks rather than months. Sentinel does not require the prime's data substrate to be modernized first.
Sentinel ships as a sub under the prime's brand, as a co-branded layer, or as a named subcontractor. Delivery model is scoped per engagement.
HIPAA Business Associate posture, 42 CFR Part 2 segregation, CMPPA agreement-readiness, and a procurement-credential ladder aligned to SOC 2 Type II, HITRUST, StateRAMP, FedRAMP, CJIS, and CMS ARS 3.1. Scoped per engagement.
From pilot subcontract to multi-state platform delivery
Fixed-scope 60-to-90-day pilot under your prime contract. One or two named use cases. Defined deliverable: written findings, dollar-at-risk estimate, and a path to broader subcontract scope. Lets the prime prove out the Sentinel layer against a specific state or federal engagement before expanding.
Typical scope: one Tier A use case (MCO PA denial outliers, HCBS ghost-enrollment, deceased capitation, etc.) executed against a defined population.
Long-cycle subcontract for one or more states or federal regions under the prime. Sentinel delivers the full seven-module stack against the prime's scope. Quarterly committee reporting, ongoing vector activation, and statutory recommendation library production.
Typical scope: annual recurring subscription plus optional shared-savings tied to recovered, prevented, or cost-avoided dollars.
Strategic partnership where Sentinel is the named PI analytics layer across the prime's portfolio. Joint go-to-market, white-label or co-branded delivery, dedicated Sentinel engagement team coordinated with the prime's delivery org. Multi-year commitment.
Typical scope: 3 to 10 state portfolio, named partnership announcement, shared procurement-credential investment.
Clarity is faster than ambiguity
Schedule a 30-minute conversation with David to scope a pilot or longer-cycle subcontract under your prime engagement.
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