CMS/EIP Fiscal Report Center: 02
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 326 796.00 29387.25 36.92
Subtotal (Total Children Is Unduplicated) 326 796.00 29387.25 36.92
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 8.50 416.25 48.97
Subtotal (Total Children Is Unduplicated) 5 8.50 416.25 48.97
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Total 804.50 29803.50 37.05
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Number of Children (Unduplicated) With at Least One Service 327
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Center 02
Flag Claims Units Chgs Paid
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R 34 21.50 795.50 0.00
U 0 0.00 0.00 0.00
B 883 723.00 26686.25 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
42 60.00 2321.75 0.00
Other 0 0.00 0.00 0.00
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Total 959 804.50 29803.50 0.00