CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:GR
Eligibility Filter:Not Part C
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 52 47.00 1739.00 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 99 91.50 3385.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 84 190.50 7048.50 37.00
Subtotal (Total Children Is Unduplicated) 152 329.00 12173.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 24.50 1837.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.00 300.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 12.00 900.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 17.00 943.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
Subtotal (Total Children Is Unduplicated) 18 59.00 4093.50 69.38
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6 660.00 330.00 0.50
Subtotal (Total Children Is Unduplicated) 6 660.00 330.00 0.50
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Total 1048.00 16596.50 15.84
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Number of Children (Unduplicated) With at Least One Service 152
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Center 09
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 251 600.75 10139.00 10139.00
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 158 446.50 6429.75 6429.75
2 0.75 27.75 0.00
Other 0 0.00 0.00 0.00
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Total 411 1048.00 16596.50 16568.75