CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2012 ending 03/31/2012 Date of Report:05/15/2012 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 72 79.750000 2941.5000 36.8840
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 50 50.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 104 125.500000 4625.0000 36.8526
TCM-T1017TL-TARGETED CASE MANAGEMENT 46 165.250000 6040.2500 36.5522
Subtotal (Total Children Is Unduplicated) 107 420.500000 13606.7500 32.3585
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.500000 75.0000 50.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 22.000000 1650.0000 75.0000
Subtotal (Total Children Is Unduplicated) 16 43.500000 2913.0000 66.9655
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.500000 75.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 11.000000 550.0000 50.0000
INTR-INTR-INTERPRETER 1 2.000000 100.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 74 7541.000000 3770.5000 0.5000
Subtotal (Total Children Is Unduplicated) 74 7555.500000 4495.5000 0.5950
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Total 8019.500000 21015.2500 2.6205
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Number of Children (Unduplicated) With at Least One Service 107
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Center 53
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 0 0.000000 0.0000 0.0000
D 3 5.750000 249.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 24 785.000000 938.0000 938.0000
T 30 1322.000000 1405.0000 1405.0000
660 5906.750000 18422.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 717 8019.500000 21015.2500 2343.0000