CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2013 ending 03/31/2013 Date of Report:05/17/2013 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 402 616.250000 22486.7500 36.4897
Subtotal (Total Children Is Unduplicated) 402 616.250000 22486.7500 36.4897
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 30.500000 1692.7500 55.5000
Subtotal (Total Children Is Unduplicated) 17 32.500000 1803.7500 55.5000
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Total 648.750000 24290.5000 37.4420
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Number of Children (Unduplicated) With at Least One Service 402
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Center 02
Flag Claims Units Chgs Paid
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R 2 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 982 614.500000 22422.0000 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
20 33.750000 1850.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1004 648.750000 24290.5000 0.0000