CMS/EIP Fiscal Report              Center: 57 
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                   444            1329.50        49191.50           37.00
Subtotal (Total Children Is Unduplicated)                444            1329.50        49191.50           37.00
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Screening, Eval, and Assessment,Class #02
  IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT           2               2.00          150.00           75.00
  IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT             1               1.00           75.00           75.00
  IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS             4               5.00          277.50           55.50
  IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT      46              46.00         3397.00           73.85
  IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT        15              15.00         1125.00           75.00
  IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS      64              64.00         3552.00           55.50
  IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF      5               5.00          375.00           75.00
  SCREEN-T1023-INTERDISCIPLINARY SCREENING                 2               2.00          100.00           50.00
Subtotal (Total Children Is Unduplicated)                 72             140.00         9051.50           64.65
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Total                                                                   1469.50        58243.00           39.63
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Number of Children (Unduplicated) With at Least One Service        446
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Center 57
Flag      Claims      Units       Chgs       Paid
-------------------------------------------------
R              0       0.00       0.00       0.00 
U              0       0.00       0.00       0.00 
B           1033     956.50   35403.50      18.50 
P            408     374.00   13838.00   13819.50 
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 
             138     139.00    9001.50       0.00 
Other          0       0.00       0.00       0.00 
-------------------------------------------------
Total       1579    1469.50   58243.00   13838.00