CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/15/2012 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 78 61.750000 2284.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 78 114.250000 4227.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 117 322.500000 11932.5000 37.0000
Subtotal (Total Children Is Unduplicated) 146 498.500000 18444.5000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 48.500000 2691.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 73.500000 5512.5000 75.0000
Subtotal (Total Children Is Unduplicated) 41 149.000000 10161.0000 68.1946
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EI Services,Class #03
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 45 2552.000000 1276.0000 0.5000
Subtotal (Total Children Is Unduplicated) 45 2552.000000 1276.0000 0.5000
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Total 3199.500000 29881.5000 9.3394
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Number of Children (Unduplicated) With at Least One Service 146
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Center 07
Flag Claims Units Chgs Paid
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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 39 1265.000000 2115.5000 2115.5000
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
745 1934.500000 27766.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 784 3199.500000 29881.5000 2115.5000