CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
Eligibility Filter:DEI Only
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 48 26.50 980.50 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 35 33.25 1230.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 50 110.50 4088.50 37.00
Subtotal (Total Children Is Unduplicated) 108 170.25 6299.25 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.00 55.50 55.50
Subtotal (Total Children Is Unduplicated) 1 2.00 130.50 65.25
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 3.50 175.00 50.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 12.00 600.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 18.00 900.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 18 3902.00 1951.00 0.50
Subtotal (Total Children Is Unduplicated) 19 3935.50 3626.00 0.92
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Total 4107.75 10055.75 2.45
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Number of Children (Unduplicated) With at Least One Service 119
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Center 01
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 62 2115.00 2047.50 2047.50
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 32 1408.50 1372.50 1372.50
284 215.25 6321.75 0.00
Other 13 369.00 314.00 0.00
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Total 391 4107.75 10055.75 3420.00