CMS/EIP Fiscal Report Center: 02
Services beginning 07/01/2009 ending 09/30/2009 Date of Report:11/16/2009 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 195 83.50 3080.25 36.89
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 138 139.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 145 229.25 8473.00 36.96
TCM-T1017TL-TARGETED CASE MANAGEMENT 149 317.00 11581.00 36.53
TCON-TCON-TRANSITION CONFERENCE 25 25.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 398 793.75 23134.25 29.15
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
Subtotal (Total Children Is Unduplicated) 1 2.00 111.00 55.50
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Total 795.75 23245.25 29.21
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Number of Children (Unduplicated) With at Least One Service 398
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Center 02
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 0 0.00 0.00 0.00
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
1029 795.75 23245.25 0.00
Other 0 0.00 0.00 0.00
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Total 1029 795.75 23245.25 0.00