CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
Payclass Filters:GR
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 6 1.500000 55.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 13 5.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 25 96.750000 3579.7500 37.0000
Subtotal (Total Children Is Unduplicated) 31 104.000000 3635.2500 34.9543
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 5 5.000000 50.0000 10.0000
TRAV-TRAVS-Travel by mile 30 706.000000 314.0900 0.4449
Subtotal (Total Children Is Unduplicated) 31 711.000000 364.0900 0.5121
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Total 815.000000 3999.3400 4.9072
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Number of Children (Unduplicated) With at Least One Service 41
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Center 52
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 7 5.250000 194.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 54 711.000000 364.0900 364.0900
81 98.750000 3441.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 142 815.000000 3999.3400 364.0900