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:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 706 1917.00 70688.50 36.87
Subtotal (Total Children Is Unduplicated) 706 1917.00 70688.50 36.87
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 31 57.00 3163.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 71 143.50 10762.50 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 25 25.00 1250.00 50.00
Subtotal (Total Children Is Unduplicated) 91 225.50 15176.00 67.30
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 0.50 25.00 50.00
Subtotal (Total Children Is Unduplicated) 1 0.50 25.00 50.00
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Total 2143.00 85889.50 40.08
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Number of Children (Unduplicated) With at Least One Service 707
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Center 07
Flag Claims Units Chgs Paid
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R 2 1.00 37.00 0.00
U 0 0.00 0.00 0.00
B 2846 1818.75 67733.00 0.00
P 94 177.50 12510.25 12510.25
D 0 0.00 0.00 0.00
S 206 134.75 5059.75 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
11 11.00 549.50 0.00
Other 0 0.00 0.00 0.00
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Total 3159 2143.00 85889.50 12510.25