CMS/EIP Fiscal Report Center: 07
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 927 2960.00 109520.00 37.00
Subtotal (Total Children Is Unduplicated) 927 2960.00 109520.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 10.00 750.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 30.00 1665.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 95 293.00 21975.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 44 44.00 2200.00 50.00
Subtotal (Total Children Is Unduplicated) 133 379.00 26701.00 70.45
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 5.00 250.00 50.00
Subtotal (Total Children Is Unduplicated) 6 5.00 250.00 50.00
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Total 3344.00 136471.00 40.81
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Number of Children (Unduplicated) With at Least One Service 928
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Center 07
Flag Claims Units Chgs Paid
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R 3 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 92 53.50 2049.50 0.00
P 5031 3288.50 134347.50 134235.00
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 5126 3344.00 136471.00 134235.00