CMS/EIP Fiscal Report Center: 06
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 56 88.750000 3283.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 30 21.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 14 35.000000 1295.0000 37.0000
Subtotal (Total Children Is Unduplicated) 56 144.750000 4578.7500 31.6321
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 3.500000 262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 3 7.000000 486.0000 69.4286
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EI Services,Class #03
INTR-T1013-INTERPRETER 3 6.000000 351.0000 58.5000
Subtotal (Total Children Is Unduplicated) 3 6.000000 351.0000 58.5000
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Total 157.750000 5415.7500 34.3312
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Number of Children (Unduplicated) With at Least One Service 56
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Center 06
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 3 6.000000 351.0000 351.0000
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
274 151.750000 5064.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 277 157.750000 5415.7500 351.0000