CMS/EIP Fiscal Report Center: 02
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 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 349 874.75 32199.25 36.81
Subtotal (Total Children Is Unduplicated) 349 874.75 32199.25 36.81
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Total 874.75 32199.25 36.81
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Number of Children (Unduplicated) With at Least One Service 349
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Center 02
Flag Claims Units Chgs Paid
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R 12 9.25 342.25 0.00
U 0 0.00 0.00 0.00
B 1045 865.50 31857.00 0.00
P 0 0.00 0.00 0.00
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 1057 874.75 32199.25 0.00