CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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 81 50.000000 1860.0000 37.2000
Subtotal (Total Children Is Unduplicated) 81 50.000000 1860.0000 37.2000
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 32 173.000000 2372.0000 13.7110
Subtotal (Total Children Is Unduplicated) 32 173.000000 2372.0000 13.7110
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Total 223.000000 4232.0000 18.9776
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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 173 173.000000 2372.0000 2372.0000
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 124 50.000000 1860.0000 0.0000
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Total 297 223.000000 4232.0000 2372.0000