CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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 301 584.75 21571.00 36.89
Subtotal (Total Children Is Unduplicated) 301 584.75 21571.00 36.89
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Total 584.75 21571.00 36.89
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Number of Children (Unduplicated) With at Least One Service 301
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Center 02
Flag Claims Units Chgs Paid
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R 16 13.25 490.25 0.00
U 0 0.00 0.00 0.00
B 777 571.50 21080.75 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
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Total 793 584.75 21571.00 0.00