CMS/EIP Fiscal Report Center: 05
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 484 225.000000 8370.0000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 152 121.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 479 1210.000000 45012.0000 37.2000
Subtotal (Total Children Is Unduplicated) 741 1556.000000 53382.0000 34.3072
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Total 1556.000000 53382.0000 34.3072
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Number of Children (Unduplicated) With at Least One Service 741
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 55 36.750000 1367.1000 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
3064 1519.250000 52014.9000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3119 1556.000000 53382.0000 0.0000