CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 66 25.75 945.50 36.72
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 48 46.00 1702.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 47 95.25 3524.25 37.00
Subtotal (Total Children Is Unduplicated) 119 167.00 6171.75 36.96
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 5.00 250.00 50.00
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 1 0.50 12.50 25.00
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 12.00 600.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 10.00 500.00 50.00
INTR-INTR-INTERPRETER 3 3.25 97.50 30.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 4.00 200.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 24 3356.00 1678.00 0.50
Subtotal (Total Children Is Unduplicated) 24 3390.75 3338.00 0.98
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Total 3557.75 9509.75 2.67
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Number of Children (Unduplicated) With at Least One Service 129
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Center 01
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 36 1024.00 759.50 759.50
D 0 0.00 0.00 0.00
S 1 1.75 64.75 0.00
H 51 1169.50 1151.00 1151.00
T 45 1196.25 1377.50 1377.50
288 165.25 6107.00 0.00
Other 1 1.00 50.00 0.00
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Total 422 3557.75 9509.75 3288.00