CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 999 2573.50 95219.50 37.00
Subtotal (Total Children Is Unduplicated) 999 2573.50 95219.50 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.00 166.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 0.50 37.50 75.00
Subtotal (Total Children Is Unduplicated) 3 3.50 204.00 58.29
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 47.00 2350.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 2 5.00 250.00 50.00
Subtotal (Total Children Is Unduplicated) 14 52.00 2600.00 50.00
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Total 2629.00 98023.50 37.29
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Number of Children (Unduplicated) With at Least One Service 1006
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Center 01
Flag Claims Units Chgs Paid
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R 8 5.00 185.00 0.00
U 0 0.00 0.00 0.00
B 3248 2380.75 88838.25 0.00
P 350 243.25 9000.25 9000.20
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 3606 2629.00 98023.50 9000.20