CMS/EIP Fiscal Report Center: 02
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/17/2009 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 344 781.00 28591.75 36.61
Subtotal (Total Children Is Unduplicated) 344 781.00 28591.75 36.61
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Total 781.00 28591.75 36.61
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Number of Children (Unduplicated) With at Least One Service 344
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Center 02
Flag Claims Units Chgs Paid
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R 85 58.00 2109.00 0.00
U 0 0.00 0.00 0.00
B 844 723.00 26482.75 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 929 781.00 28591.75 0.00