CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:OTHER
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 33 11.750000 434.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 89 238.500000 8510.0000 35.6813
Subtotal (Total Children Is Unduplicated) 90 250.250000 8944.7500 35.7433
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Total 250.250000 8944.7500 35.7433
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Number of Children (Unduplicated) With at Least One Service 90
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Center 55
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
299 250.250000 8944.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 299 250.250000 8944.7500 0.0000