CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
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 272 604.00 22088.50 36.57
Subtotal (Total Children Is Unduplicated) 272 604.00 22088.50 36.57
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Total 604.00 22088.50 36.57
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Number of Children (Unduplicated) With at Least One Service 272
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Center 02
Flag Claims Units Chgs Paid
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R 17 13.50 499.50 0.00
U 0 0.00 0.00 0.00
B 649 536.50 19637.25 0.00
P 1 0.50 18.50 0.00
D 0 0.00 0.00 0.00
S 1 1.25 46.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
43 52.25 1887.00 0.00
Other 0 0.00 0.00 0.00
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Total 711 604.00 22088.50 0.00