CMS/EIP Fiscal Report Center: 07
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 1018 3112.75 115162.50 37.00
Subtotal (Total Children Is Unduplicated) 1018 3112.75 115162.50 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 6.00 450.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 79.00 4384.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 120 335.00 25050.00 74.78
SCREEN-T1023-INTERDISCIPLINARY SCREENING 50 50.00 2500.00 50.00
Subtotal (Total Children Is Unduplicated) 152 470.00 32384.50 68.90
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 7.00 350.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
Subtotal (Total Children Is Unduplicated) 9 8.00 400.00 50.00
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Total 3590.75 147947.00 41.20
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Number of Children (Unduplicated) With at Least One Service 1023
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Center 07
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 11 8.00 296.00 0.00
P 5198 3582.75 147651.00 147651.00
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 5209 3590.75 147947.00 147651.00