CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2010 ending 09/30/2010 Date of Report:11/17/2010 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
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 3.000000 100.0000 33.3333
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 100.0000 25.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 100.0000 25.0000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 8 13.000000 405.5000 31.1923
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 14.000000 350.0000 25.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 100.0000 25.0000
Subtotal (Total Children Is Unduplicated) 19 42.000000 1155.5000 27.5119
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EI Services,Class #03
ECE-ECE-EARLY CHILDHOOD EDUCATION 109 7054.000000 63859.0000 9.0529
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 100 4292.000000 107300.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 65 1155.000000 28875.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 36 166.250000 8312.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 24 131.000000 6300.0000 48.0916
HERN-EIIF_NM-EI HEARING SERVICES AFTER SHINE NONMED 7 4.750000 237.5000 50.0000
HERN-T1027SC-EI HEARING SERVICES AFTER SHINE 2 1.500000 75.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 66 184.250000 12506.8900 67.8800
PHY-97110-PT SESSION BY LICENSED PT 65 142.750000 9689.8700 67.8800
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.750000 87.5000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 94 261.500000 17750.6200 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 11 20.000000 264.0000 13.2000
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 14 76.000000 3800.0000 50.0000
Subtotal (Total Children Is Unduplicated) 375 13490.75000 259057.8800 19.2026
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Total 13532.750000 260213.3800 19.2284
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Number of Children (Unduplicated) With at Least One Service 394
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
25 77.000000 3850.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 25 77.000000 3850.0000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
389 5525.000000 148089.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 389 5525.000000 148089.8000 0.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5 13.500000 880.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5 13.500000 880.6200 0.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
32 33.000000 2029.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 32 33.000000 2029.9500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
75 203.500000 9230.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 75 203.500000 9230.5000 0.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
415 7680.750000 96132.5100 95839.4100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 415 7680.750000 96132.5100 95839.4100