CMS/EIP Fiscal Report Center: 55
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 29 12.75 471.75 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 47 54.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 12 6.00 222.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 29 147.00 5439.00 37.00
Subtotal (Total Children Is Unduplicated) 64 219.75 6132.75 27.91
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.00 75.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.00 75.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 16.97 1272.56 74.99
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.50 262.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.00 555.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 9.00 675.00 75.00
Subtotal (Total Children Is Unduplicated) 27 42.47 2990.06 70.40
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Total 262.22 9122.81 34.79
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Number of Children (Unduplicated) With at Least One Service 65
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Center 55
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 7.00 486.00 486.00
D 9 9.75 702.75 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 18 25.47 1754.06 1754.06
235 220.00 6180.00 0.00
Other 0 0.00 0.00 0.00
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Total 267 262.22 9122.81 2240.06