CMS/EIP Fiscal Report Center: 05
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
Payclass Filters:GR
Eligibility Filter:DEI Only
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 37 16.75 619.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 9 9.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 9.25 342.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 6 16.00 592.00 37.00
Subtotal (Total Children Is Unduplicated) 42 51.00 1554.00 30.47
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Total 51.00 1554.00 30.47
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Number of Children (Unduplicated) With at Least One Service 42
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Center 05
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 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
115 51.00 1554.00 0.00
Other 0 0.00 0.00 0.00
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Total 115 51.00 1554.00 0.00