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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 576 1523.500000 56674.2000 37.2000
Subtotal (Total Children Is Unduplicated) 576 1523.500000 56674.2000 37.2000
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Total 1523.500000 56674.2000 37.2000
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Number of Children (Unduplicated) With at Least One Service 576
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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 2281 1451.500000 53995.8000 27369.9800
P 0 0.000000 0.0000 0.0000
D 2 1.250000 46.5000 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 67 52.250000 1943.7000 0.0000
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Total 2377 1523.500000 56674.2000 27369.9800