CMS/EIP Fiscal Report Center: 57
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/20/2020 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 33 18.250000 675.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 0.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 37 220.000000 8140.0000 37.0000
Subtotal (Total Children Is Unduplicated) 54 239.000000 8815.2500 36.8839
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Total 239.000000 8815.2500 36.8839
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Number of Children (Unduplicated) With at Least One Service 54
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Center 57
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
184 239.000000 8815.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 184 239.000000 8815.2500 0.0000