CMS/EIP Fiscal Report Center: 02
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 31 21.25 786.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 35 59.75 2173.75 36.38
TCM-T1017TL-TARGETED CASE MANAGEMENT 25 94.00 3376.25 35.92
Subtotal (Total Children Is Unduplicated) 46 175.00 6336.25 36.21
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Screening, Eval, and Assessment,Class #02
EVAL-EVAL-DEVELOPMENTAL EVALUATION 1 1.00 50.00 50.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 14.50 1087.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.00 388.50 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.00 150.00 75.00
Subtotal (Total Children Is Unduplicated) 10 30.00 2088.50 69.62
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EI Services,Class #03
INTR-INTR-INTERPRETER 3 13.50 592.50 43.89
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 28 2113.00 1056.50 0.50
Subtotal (Total Children Is Unduplicated) 28 2126.50 1649.00 0.78
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Total 2331.50 10073.75 4.32
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Number of Children (Unduplicated) With at Least One Service 48
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Center 02
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 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 49 1147.00 2365.50 2365.50
221 1184.50 7708.25 0.00
Other 0 0.00 0.00 0.00
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Total 270 2331.50 10073.75 2365.50