CMS/EIP Fiscal Report Center: 05
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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 541 228.250000 8490.9000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 150 127.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 503 1270.500000 47262.6000 37.2000
Subtotal (Total Children Is Unduplicated) 828 1626.250000 55753.5000 34.2835
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Total 1626.250000 55753.5000 34.2835
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Number of Children (Unduplicated) With at Least One Service 828
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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 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
3091 1624.500000 55688.4000 0.0000
Other 6 1.750000 65.1000 0.0000
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Total 3097 1626.250000 55753.5000 0.0000