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: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 43 54.750000 2025.7500 37.0000
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 44 44.000000 0.0000 0.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 82 98.000000 3626.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 31 124.500000 4588.0000 36.8514
Subtotal (Total Children Is Unduplicated) 88 321.250000 10239.7500 31.8747
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 1 5.000000 250.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 21.500000 1612.5000 75.0000
Subtotal (Total Children Is Unduplicated) 12 34.500000 2345.5000 67.9855
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EI Services,Class #03
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 6.000000 300.0000 50.0000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 62 5591.000000 2795.5000 0.5000
Subtotal (Total Children Is Unduplicated) 62 5598.000000 3145.5000 0.5619
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Total 5953.750000 15730.7500 2.6422
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Number of Children (Unduplicated) With at Least One Service 88
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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 26 735.000000 1360.5000 1360.5000
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 45 2061.500000 1390.0000 1390.0000
443 3157.250000 12980.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 514 5953.750000 15730.7500 2750.5000