CMS/EIP Fiscal Report Center: 05
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 1
List order: No List
Payclass Filters:MED
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 46 206.000000 7663.2000 37.2000
Subtotal (Total Children Is Unduplicated) 46 206.000000 7663.2000 37.2000
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Total 206.000000 7663.2000 37.2000
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Number of Children (Unduplicated) With at Least One Service 46
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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 219 203.750000 7579.5000 3645.6000
P 0 0.000000 0.0000 0.0000
D 1 1.000000 37.2000 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 2 1.250000 46.5000 0.0000
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Total 222 206.000000 7663.2000 3645.6000