CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2008 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 1402 7616.50 281788.75 37.00
Subtotal (Total Children Is Unduplicated) 1402 7616.50 281788.75 37.00
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Total 7616.50 281788.75 37.00
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Number of Children (Unduplicated) With at Least One Service 1402
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Center 06
Flag Claims Units Chgs Paid
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R 2 1.50 55.50 0.00
U 0 0.00 0.00 0.00
B 7257 4738.00 175284.25 1591.00
P 4404 2877.00 106449.00 106449.00
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 11663 7616.50 281788.75 108040.00