CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 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 194 92.50 3413.25 36.90
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 261 336.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 82 59.50 2201.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 259 773.25 28323.50 36.63
TCON-TCON-TRANSITION CONFERENCE 35 35.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 454 1296.25 33938.25 26.18
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 2 3.50 225.00 64.29
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 7.00 525.00 75.00
Subtotal (Total Children Is Unduplicated) 7 10.50 750.00 71.43
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Total 1306.75 34688.25 26.55
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Number of Children (Unduplicated) With at Least One Service 454
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Center 55
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 1 1.00 37.00 37.00
D 34 34.25 1410.00 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
1592 1271.50 33241.25 0.00
Other 0 0.00 0.00 0.00
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Total 1627 1306.75 34688.25 37.00