CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/16/2009 Page: 1
Payclass Filters:OTHER
Eligibility Filter:Not Part C
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 11 40.25 1489.25 37.00
Subtotal (Total Children Is Unduplicated) 11 40.25 1489.25 37.00
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Total 40.25 1489.25 37.00
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Number of Children (Unduplicated) With at Least One Service 11
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Center 53
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 16 15.25 564.25 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
28 25.00 925.00 0.00
Other 0 0.00 0.00 0.00
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Total 44 40.25 1489.25 0.00