CMS/EIP Fiscal Report Center: 07
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 753 2150.50 79457.50 36.95
Subtotal (Total Children Is Unduplicated) 753 2150.50 79457.50 36.95
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 4.00 300.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 98 294.00 22050.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 29 29.00 1450.00 50.00
Subtotal (Total Children Is Unduplicated) 112 327.00 23800.00 72.78
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 2.50 125.00 50.00
Subtotal (Total Children Is Unduplicated) 2 2.50 125.00 50.00
----------------------------------------------------------------------------------------------------------------
Total 2480.00 103382.50 41.69
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 761
----------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 1 0.50 18.50 0.00
U 0 0.00 0.00 0.00
B 2114 1540.25 62338.00 0.00
P 1229 939.25 41026.00 41010.75
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 3344 2480.00 103382.50 41010.75