CMS/EIP Fiscal Report Center: 54
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:MED
Eligibility Filter:DEI Only
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 3 8.75 323.75 37.00
Subtotal (Total Children Is Unduplicated) 3 8.75 323.75 37.00
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 10.00 500.00 50.00
Subtotal (Total Children Is Unduplicated) 1 10.00 500.00 50.00
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Total 18.75 823.75 43.93
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Number of Children (Unduplicated) With at Least One Service 3
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Center 54
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 27 18.50 814.50 0.00
P 1 0.25 9.25 9.25
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 28 18.75 823.75 9.25