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
Payclass Filters:MED
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 661 2142.750000 79710.3000 37.2000
Subtotal (Total Children Is Unduplicated) 661 2142.750000 79710.3000 37.2000
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Total 2142.750000 79710.3000 37.2000
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Number of Children (Unduplicated) With at Least One Service 661
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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 3378 2070.750000 77031.9000 14756.4500
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
10 6.750000 251.1000 0.0000
Other 89 65.250000 2427.3000 0.0000
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Total 3477 2142.750000 79710.3000 14756.4500