CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 413 286.500000 10489.5000 36.6126
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 195 234.750000 8648.7500 36.8424
TCM-T1017TL-TARGETED CASE MANAGEMENT 167 280.000000 10230.5000 36.5375
Subtotal (Total Children Is Unduplicated) 481 801.250000 29368.7500 36.6537
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Total 801.250000 29368.7500 36.6537
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Number of Children (Unduplicated) With at Least One Service 481
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Center 02
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1577 801.250000 29368.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1577 801.250000 29368.7500 0.0000