CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Payclass Filters:LEA
Eligibility Filter:Program Patients
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 0.75 37.50 50.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 1.00 55.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 20 20.00 1110.00 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 35.50 1475.00 41.55
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 4.00 200.00 50.00
Subtotal (Total Children Is Unduplicated) 49 61.25 2878.00 46.99
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 8 15.50 775.00 50.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 81 8316.00 74844.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 102 8673.00 216825.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 54 2297.00 57425.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 86 651.50 32537.50 49.94
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 28 443.00 22150.00 50.00
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 3 7.25 362.50 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 7 11.25 562.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 65 312.75 21229.47 67.88
PHY-97110-PT SESSION BY LICENSED PT 65 250.50 17003.94 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 11 10.50 525.00 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 110 462.50 31394.50 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 21 70.00 924.00 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 74.00 37.00 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 17 70.50 3525.00 50.00
Subtotal (Total Children Is Unduplicated) 392 21665.3 480120.41 22.16
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Total 21726.50 482998.41 22.23
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Number of Children (Unduplicated) With at Least One Service 440
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
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 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
50 175.25 8762.50 0.00
Other 0 0.00 0.00 0.00
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Total 50 175.25 8762.50 0.00
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
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 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
731 11673.50 325167.83 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 731 11673.50 325167.83 0.00
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
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 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
21 11694.50 326333.33 0.00
Other 0 0.00 0.00 0.00
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Total 21 11694.50 326333.33 0.00
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
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 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
97 11905.00 338489.88 0.00
Other 0 0.00 0.00 0.00
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Total 97 11905.00 338489.88 0.00
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
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 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
205 12417.25 363764.88 0.00
Other 0 0.00 0.00 0.00
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Total 205 12417.25 363764.88 0.00
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
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 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
407 21726.50 482998.41 0.00
Other 0 0.00 0.00 0.00
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Total 407 21726.50 482998.41 0.00