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: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 486 1345.750000 50061.9000 37.2000
Subtotal (Total Children Is Unduplicated) 486 1345.750000 50061.9000 37.2000
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Total 1345.750000 50061.9000 37.2000
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Number of Children (Unduplicated) With at Least One Service 486
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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 2037 1137.000000 42296.4000 40559.6900
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
25 13.500000 502.2000 0.0000
Other 315 195.000000 7254.0000 6956.4000
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Total 2378 1345.750000 50061.9000 47516.0900