CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
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 1044 1048.00 38776.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 407 421.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 628 820.50 30358.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 623 1687.00 62409.75 36.99
TCON-TCON-TRANSITION CONFERENCE 30 30.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 1333 4006.50 131544.25 32.83
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 77.00 4273.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 58 122.50 9187.50 75.00
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.00 72.78 72.78
NUTR-NUTR-UNSPECIFIED NUTRITIONAL EVAL 1 1.00 50.00 50.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 17 17.00 850.00 50.00
Subtotal (Total Children Is Unduplicated) 79 218.50 14433.78 66.06
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 6.00 300.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 63 3679.00 1839.50 0.50
Subtotal (Total Children Is Unduplicated) 76 3685.00 2139.50 0.58
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Total 7910.00 148117.53 18.73
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Number of Children (Unduplicated) With at Least One Service 1334
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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 0 0.00 0.00 0.00
P 2451 2586.00 50353.00 50353.00
D 0 0.00 0.00 0.00
S 8 5.00 261.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
4692 5319.00 97503.53 0.00
Other 0 0.00 0.00 0.00
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Total 7151 7910.00 148117.53 50353.00