CMS/EIP Fiscal Report Center: 06
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 723 2043.00 75591.00 37.00
Subtotal (Total Children Is Unduplicated) 723 2043.00 75591.00 37.00
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Total 2043.00 75591.00 37.00
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Number of Children (Unduplicated) With at Least One Service 723
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Center 06
Flag Claims Units Chgs Paid
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R 8 4.00 148.00 111.00
U 0 0.00 0.00 0.00
B 2102 1461.00 54057.00 0.00
P 877 578.00 21386.00 21386.00
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 2987 2043.00 75591.00 21497.00