CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 787 395.00 14615.00 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 710 832.25 30774.75 36.98
TCM-T1017TL-TARGETED CASE MANAGEMENT 874 2446.75 90335.50 36.92
Subtotal (Total Children Is Unduplicated) 1576 3674.00 135725.25 36.94
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.50 262.50 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.50 487.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 16.00 1200.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.00 225.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.50 112.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 20.50 1137.75 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.50 562.50 75.00
Subtotal (Total Children Is Unduplicated) 19 58.50 3987.75 68.17
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 14.50 725.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 1.00 25.00 25.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6 862.00 431.00 0.50
Subtotal (Total Children Is Unduplicated) 12 877.50 1181.00 1.35
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Total 4610.00 140894.00 30.56
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Number of Children (Unduplicated) With at Least One Service 1581
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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 2 1.75 64.75 64.75
D 0 0.00 0.00 0.00
S 88 90.25 3339.25 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
5880 4465.50 134000.50 0.00
Other 36 52.50 3489.50 0.00
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Total 6006 4610.00 140894.00 64.75