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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 494 216.500000 8053.8000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 94 81.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 489 1228.750000 45678.2500 37.1746
Subtotal (Total Children Is Unduplicated) 767 1526.750000 53732.0500 35.1937
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Total 1526.750000 53732.0500 35.1937
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Number of Children (Unduplicated) With at Least One Service 767
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Center 05
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 1 0.250000 9.2500 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
2943 1523.500000 53611.2000 0.0000
Other 5 3.000000 111.6000 0.0000
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Total 2949 1526.750000 53732.0500 0.0000