CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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 3 3.75 187.50 50.00
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 18 22.50 993.75 44.17
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 14.50 887.50 61.21
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.00 150.00 75.00
Subtotal (Total Children Is Unduplicated) 31 42.75 2218.75 51.90
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 9.25 462.50 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 2.00 100.00 50.00
CONIP-CONIP-CONSULT, ITDS, PHONE 1 0.25 6.25 25.00
ECE-ECE-EARLY CHILDHOOD EDUCATION 58 8732.00 78588.00 9.00
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 80 5477.00 136925.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 47 1561.00 39025.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 68 268.25 13412.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 36 410.25 20512.50 50.00
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 12 42.00 2100.00 50.00
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 13 57.25 2862.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 52 292.75 19871.87 67.88
PHY-97110-PT SESSION BY LICENSED PT 53 231.00 15680.28 67.88
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 12 27.75 1387.50 50.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 129 554.50 37639.46 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 17 19.50 257.40 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 38.00 19.00 0.50
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 21 102.00 5100.00 50.00
Subtotal (Total Children Is Unduplicated) 363 17824.8 373949.76 20.98
----------------------------------------------------------------------------------------------------------------
Total 17867.50 376168.51 21.05
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 391
----------------------------------------------------------------------------------------------------------------
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
547 7397.25 204726.53 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 547 7397.25 204726.53 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 7 18.50 1202.14 1202.14
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
67 283.25 18053.79 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 74 301.75 19255.93 1202.14
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
187 381.75 21174.99 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 187 381.75 21174.99 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
109 276.75 13852.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 109 276.75 13852.00 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
413 9510.00 117159.06 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 413 9510.00 117159.06 0.00