CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 413 287.250000 10517.2500 36.6136
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 196 236.750000 8722.7500 36.8437
TCM-T1017TL-TARGETED CASE MANAGEMENT 511 904.000000 33087.2500 36.6009
Subtotal (Total Children Is Unduplicated) 549 1428.000000 52327.2500 36.6437
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
Subtotal (Total Children Is Unduplicated) 2 3.000000 166.5000 55.5000
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Total 1431.000000 52493.7500 36.6833
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Number of Children (Unduplicated) With at Least One Service 549
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Center 02
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 683 449.250000 16391.0000 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
1810 981.750000 36102.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2493 1431.000000 52493.7500 0.0000