CMS/EIP Fiscal Report Center: 05
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 30 9.25 342.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 15 15.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 6.50 240.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 11 31.00 1147.00 37.00
Subtotal (Total Children Is Unduplicated) 45 61.75 1729.75 28.01
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2 255.00 127.50 0.50
Subtotal (Total Children Is Unduplicated) 2 255.00 127.50 0.50
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Total 316.75 1857.25 5.86
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Number of Children (Unduplicated) With at Least One Service 45
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Center 05
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 2 1.25 46.25 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
112 315.50 1811.00 0.00
Other 0 0.00 0.00 0.00
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Total 114 316.75 1857.25 0.00