CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
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 760 1947.75 72066.75 37.00
Subtotal (Total Children Is Unduplicated) 760 1947.75 72066.75 37.00
----------------------------------------------------------------------------------------------------------------
Total 1947.75 72066.75 37.00
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 760
----------------------------------------------------------------------------------------------------------------
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 2986 1947.25 72048.25 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
0 0.00 0.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2987 1947.75 72066.75 0.00