CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
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
CASE-CASE-NON-TCM CASE MANAGEMENT 12 6.00 222.00 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 10 11.25 416.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 38 149.50 5531.50 37.00
Subtotal (Total Children Is Unduplicated) 43 166.75 6169.75 37.00
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EI Services,Class #03
INTR-INTR-INTERPRETER 1 2.00 117.00 58.50
Subtotal (Total Children Is Unduplicated) 1 2.00 117.00 58.50
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Total 168.75 6286.75 37.25
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Number of Children (Unduplicated) With at Least One Service 44
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Center 06
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 0 0.00 0.00 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
229 168.75 6286.75 27.75
Other 0 0.00 0.00 0.00
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Total 229 168.75 6286.75 27.75