CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
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 376 497.000000 18315.0000 36.8511
Subtotal (Total Children Is Unduplicated) 376 497.000000 18315.0000 36.8511
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 21.500000 1193.2500 55.5000
Subtotal (Total Children Is Unduplicated) 11 21.500000 1193.2500 55.5000
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9 34.000000 1700.0000 50.0000
Subtotal (Total Children Is Unduplicated) 9 34.000000 1700.0000 50.0000
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Total 552.500000 21208.2500 38.3860
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Number of Children (Unduplicated) With at Least One Service 380
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Center 02
Flag Claims Units Chgs Paid
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R 48 28.250000 1082.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 787 522.750000 20070.5000 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
1 1.500000 55.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 836 552.500000 21208.2500 0.0000