CMS/EIP Fiscal Report Center: 05
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 585 1817.750000 67573.7000 37.1744
Subtotal (Total Children Is Unduplicated) 585 1817.750000 67573.7000 37.1744
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Total 1817.750000 67573.7000 37.1744
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Number of Children (Unduplicated) With at Least One Service 585
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Center 05
Flag Claims Units Chgs Paid
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R 6 3.000000 111.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 2937 1814.750000 67462.1000 31536.1400
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2943 1817.750000 67573.7000 31536.1400