CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2012 ending 06/30/2012 Date of Report:08/16/2012 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:DEI Only
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1 0.500000 18.5000 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.500000 55.5000 37.0000
Subtotal (Total Children Is Unduplicated) 2 3.000000 74.0000 24.6667
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EI Services,Class #03
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2 485.000000 242.5000 0.5000
Subtotal (Total Children Is Unduplicated) 2 486.000000 292.5000 0.6019
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Total 489.000000 366.5000 0.7495
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Number of Children (Unduplicated) With at Least One Service 2
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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 2 145.000000 72.5000 72.5000
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 1 110.000000 55.0000 55.0000
7 234.000000 239.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10 489.000000 366.5000 127.5000