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
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 530 1317.500000 49011.0000 37.2000
Subtotal (Total Children Is Unduplicated) 530 1317.500000 49011.0000 37.2000
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Total 1317.500000 49011.0000 37.2000
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Number of Children (Unduplicated) With at Least One Service 530
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Center 05
Flag Claims Units Chgs Paid
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R 27 18.500000 688.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 2062 1247.750000 46416.3000 23724.3800
P 0 0.000000 0.0000 0.0000
D 1 0.250000 9.3000 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 65 51.000000 1897.2000 0.0000
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Total 2155 1317.500000 49011.0000 23724.3800