CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 884 2853.75 105579.50 37.00
Subtotal (Total Children Is Unduplicated) 884 2853.75 105579.50 37.00
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 8.00 600.00 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.00 222.00 55.50
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 22.00 1221.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 78 246.00 18450.00 75.00
SCREEN-T1023-INTERDISCIPLINARY SCREENING 30 30.00 1500.00 50.00
Subtotal (Total Children Is Unduplicated) 105 310.00 21993.00 70.95
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 5.00 250.00 50.00
Subtotal (Total Children Is Unduplicated) 6 5.00 250.00 50.00
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Total 3168.75 127822.50 40.34
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Number of Children (Unduplicated) With at Least One Service 884
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Center 07
Flag Claims Units Chgs Paid
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R 3 2.00 74.00 0.00
U 0 0.00 0.00 0.00
B 84 46.25 1768.25 0.00
P 4743 3037.75 122738.75 122626.25
D 0 0.00 0.00 0.00
S 89 46.25 1702.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
47 36.50 1539.50 0.00
Other 0 0.00 0.00 0.00
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Total 4966 3168.75 127822.50 122626.25