CMS/EIP Fiscal Report Center: 05
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 421 1468.25 54325.25 37.00
Subtotal (Total Children Is Unduplicated) 421 1468.25 54325.25 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.50 138.75 55.50
Subtotal (Total Children Is Unduplicated) 2 2.50 138.75 55.50
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Total 1470.75 54464.00 37.03
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Number of Children (Unduplicated) With at Least One Service 422
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Center 05
Flag Claims Units Chgs Paid
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R 78 42.25 1563.25 0.00
U 0 0.00 0.00 0.00
B 2595 1428.50 52900.75 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 2673 1470.75 54464.00 0.00