CMS/EIP Fiscal Report Center: 55
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 339 1004.50 37027.75 36.86
Subtotal (Total Children Is Unduplicated) 339 1004.50 37027.75 36.86
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 47 70.50 5287.50 75.00
Subtotal (Total Children Is Unduplicated) 47 70.50 5287.50 75.00
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Total 1075.00 42315.25 39.36
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Number of Children (Unduplicated) With at Least One Service 339
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Center 55
Flag Claims Units Chgs Paid
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R 5 4.75 175.75 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 1075 1070.25 42139.50 42139.50
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 1080 1075.00 42315.25 42139.50