CMS/EIP Fiscal Report Center: 57
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 568 1876.00 69393.50 36.99
Subtotal (Total Children Is Unduplicated) 568 1876.00 69393.50 36.99
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Total 1876.00 69393.50 36.99
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Number of Children (Unduplicated) With at Least One Service 568
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Center 57
Flag Claims Units Chgs Paid
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R 136 157.50 5827.50 0.00
U 0 0.00 0.00 0.00
B 1101 1088.50 40256.00 0.00
P 658 630.00 23310.00 23309.90
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 1895 1876.00 69393.50 23309.90