CMS/EIP Fiscal Report Center: 54
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 2 1.25 46.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.00 37.00 37.00
Subtotal (Total Children Is Unduplicated) 3 3.25 83.25 25.62
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EI Services,Class #03
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.25 12.50 50.00
INTR-INTR-INTERPRETER 1 4.00 200.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2 492.00 363.80 0.74
Subtotal (Total Children Is Unduplicated) 2 496.25 576.30 1.16
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Total 499.50 659.55 1.32
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Number of Children (Unduplicated) With at Least One Service 3
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Center 54
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 5 370.25 271.50 271.50
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 0 0.00 0.00 0.00
17 129.25 388.05 0.00
Other 0 0.00 0.00 0.00
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Total 22 499.50 659.55 271.50