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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 93 91.500000 3403.8000 37.2000
Subtotal (Total Children Is Unduplicated) 93 91.500000 3403.8000 37.2000
-----------------------------------------------------------------------------------------------------------------------
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
-----------------------------------------------------------------------------------------------------------------------
Total 176.500000 4559.8000 25.8346
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 117
-----------------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 192 91.500000 3403.8000 0.0000
---------------------------------------------------------
Total 277 176.500000 4559.8000 1156.0000