CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 4 3.250000 120.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 2.250000 83.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 3 3.750000 138.7500 37.0000
Subtotal (Total Children Is Unduplicated) 4 9.250000 342.2500 37.0000
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Total 9.250000 342.2500 37.0000
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Number of Children (Unduplicated) With at Least One Service 4
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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 7 3.750000 138.7500 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
11 5.500000 203.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 18 9.250000 342.2500 0.0000