CMS/EIP Fiscal Report Center: 07
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 730 1941.00 71567.25 36.87
Subtotal (Total Children Is Unduplicated) 730 1941.00 71567.25 36.87
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 47.50 2636.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 84 166.50 12487.50 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 33 33.00 1650.00 50.00
Subtotal (Total Children Is Unduplicated) 107 247.00 16773.75 67.91
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 0.50 25.00 50.00
Subtotal (Total Children Is Unduplicated) 1 0.50 25.00 50.00
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Total 2188.50 88366.00 40.38
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Number of Children (Unduplicated) With at Least One Service 735
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Center 07
Flag Claims Units Chgs Paid
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R 2 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 3046 1989.00 74273.00 0.00
P 106 198.50 14056.00 14056.00
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
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Total 3154 2188.50 88366.00 14056.00