CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 1
List order: No List
Payclass Filters:OTHER
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 89 80.750000 3003.9000 37.2000
Subtotal (Total Children Is Unduplicated) 89 80.750000 3003.9000 37.2000
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 24 85.000000 1156.0000 13.6000
Subtotal (Total Children Is Unduplicated) 24 85.000000 1156.0000 13.6000
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Total 165.750000 4159.9000 25.0974
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Number of Children (Unduplicated) With at Least One Service 113
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Center 07
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 85 85.000000 1156.0000 1156.0000
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
0 0.000000 0.0000 0.0000
Other 177 80.750000 3003.9000 0.0000
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Total 262 165.750000 4159.9000 1156.0000