Synthetic demonstration data — State of Cascadia is fictional. Methodology is real.
SEAM FINDER
Provenance Advisors
← All findings
Improper payment — county attribution error

County Transfer Gaps

3,164
Members affected
$7.1M
Estimated exposure
3.7
Avg months at risk
$5.2M–9M
Exposure range

What this is

Member moved counties; the old county terminated, the new county's span started late, and MMIS kept paying under the stale county code the whole time.

Why single-system review misses this

Each county's caseload looks clean on its own. The gap exists between two county queues — a uniquely county-administered failure no county-level report can see.

One member, two systems

Member CAS-00000092 — the eligibility record and the payment record, on one clock. The hatched window is the seam.

CBES eligibility spanMMIS enrollment spanthe seam — paid under a stale county code
202420252026Paid under a stale county code — 4.9 mo≈ $601/mo at riskvendor cutover 10/25run date 06/26CBESeligibilityMMISpaymentCBES EXPANSION-ADULT · Alderwood County · 2023-04-17 → 2024-02-09EXPANSION-ADULTCBES EXPANSION-ADULT · Basalt County · 2024-07-08 → openEXPANSION-ADULTMMIS EXPANSION-ADULT · Silverline Health · MERIDIAN · 2023-04-17 → open · capitation YEXPANSION-ADULT · MERIDIAN≈ $601 paid this month≈ $601 paid this month≈ $601 paid this month≈ $601 paid this month≈ $601 paid this month

The exposure math, in the open

members × avg monthly capitation × avg months of coverage gap

3,164members×$601avg per month×3.7avg months≈$7.1Mestimated exposure
Example members:CAS-00000092CAS-00000213CAS-00000243CAS-00000273CAS-00000287