CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 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 35 45.500000 1683.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 31 41.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 15 46.250000 1711.2500 37.0000
Subtotal (Total Children Is Unduplicated) 35 133.000000 3394.7500 25.5244
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.500000 804.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
Subtotal (Total Children Is Unduplicated) 11 28.500000 1854.7500 65.0789
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 6.000000 300.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 4 5.000000 50.0000 10.0000
TRAV-TRAVS-Travel by mile 25 1478.000000 657.8000 0.4451
Subtotal (Total Children Is Unduplicated) 25 1489.000000 1007.8000 0.6768
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Total 1650.500000 6257.3000 3.7912
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Number of Children (Unduplicated) With at Least One Service 35
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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 0 0.000000 0.0000 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 17 345.000000 794.2000 8.0100
41 1116.000000 1740.3900 0.0000
Other 214 189.500000 3722.7100 0.0000
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Total 272 1650.500000 6257.3000 8.0100