CMS/EIP Fiscal Report              Center: 07 
Services beginning 10/01/2008 ending 12/31/2008                Date of Report:02/17/2009   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                   720            2071.25        76534.50           36.95
Subtotal (Total Children Is Unduplicated)                720            2071.25        76534.50           36.95
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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-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS      15              30.00         1665.00           55.50
  IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF     82             245.00        18375.00           75.00
  SCREEN-T1023-INTERDISCIPLINARY SCREENING                20              20.00         1000.00           50.00
Subtotal (Total Children Is Unduplicated)                 91             299.00        21340.00           71.37
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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
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Total                                                                   2372.75        97999.50           41.30
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Number of Children (Unduplicated) With at Least One Service        722
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Center 07
Flag      Claims      Units       Chgs       Paid
-------------------------------------------------
R              1       0.50      18.50       0.00 
U              0       0.00       0.00       0.00 
B           1964    1394.25   56000.25       0.00 
P           1140     841.50   36375.25   36360.00 
D              1       0.50      18.50       0.00 
S            149     112.75    4726.75       0.00 
H              0       0.00       0.00       0.00 
T              0       0.00       0.00       0.00 
              22      23.25     860.25       0.00 
Other          0       0.00       0.00       0.00 
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Total       3277    2372.75   97999.50   36360.00