CMS/EIP Fiscal Report Center: 05
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 285 154.000000 5698.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 240 222.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 266 758.000000 28046.0000 37.0000
Subtotal (Total Children Is Unduplicated) 501 1134.000000 33744.0000 29.7566
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.500000 637.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 9.000000 675.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 14.500000 1087.5000 75.0000
Subtotal (Total Children Is Unduplicated) 15 32.000000 2400.0000 75.0000
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 3.750000 187.5000 50.0000
CONIF-CONIF-CONSULT, FACE TO FACE 5 6.000000 300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 26.750000 1337.5000 50.0000
TRAV-TRAVS-Travel by mile 19 419.000000 186.4800 0.4451
Subtotal (Total Children Is Unduplicated) 34 455.500000 2011.4800 4.4160
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Total 1621.500000 38155.4800 23.5310
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Number of Children (Unduplicated) With at Least One Service 505
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Center 05
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 0 0.000000 0.0000 0.0000
2353 1621.500000 38155.4800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2353 1621.500000 38155.4800 0.0000