CMS/EIP Fiscal Report Center: 09
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 42 27.25 1008.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 136 98.50 3644.50 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 128 290.25 10739.25 37.00
Subtotal (Total Children Is Unduplicated) 229 416.00 15392.00 37.00
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 32.50 2437.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.00 600.00 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.00 300.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 23 36.50 2025.75 55.50
Subtotal (Total Children Is Unduplicated) 26 81.00 5363.25 66.21
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 19 1485.00 742.50 0.50
Subtotal (Total Children Is Unduplicated) 19 1485.00 742.50 0.50
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Total 1982.00 21497.75 10.85
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Number of Children (Unduplicated) With at Least One Service 231
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Center 09
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 325 862.50 12476.50 12476.50
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 213 1117.75 8956.50 8956.50
2 1.75 64.75 0.00
Other 0 0.00 0.00 0.00
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Total 540 1982.00 21497.75 21433.00