CMS/EIP Fiscal Report Center: 07
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 958 3036.00 112313.50 36.99
Subtotal (Total Children Is Unduplicated) 958 3036.00 112313.50 36.99
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 6.00 450.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 33 63.50 3524.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 98 282.00 21075.00 74.73
SCREEN-T1023-INTERDISCIPLINARY SCREENING 38 38.00 1900.00 50.00
Subtotal (Total Children Is Unduplicated) 124 389.50 26949.25 69.19
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 7.00 350.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
Subtotal (Total Children Is Unduplicated) 9 8.00 400.00 50.00
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Total 3433.50 139662.75 40.68
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Number of Children (Unduplicated) With at Least One Service 960
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Center 07
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 11 8.00 296.00 0.00
P 4847 3261.25 133146.75 133146.75
D 0 0.00 0.00 0.00
S 271 134.75 4976.50 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
39 28.50 1206.50 0.00
Other 2 1.00 37.00 0.00
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Total 5170 3433.50 139662.75 133146.75