CMS/EIP Fiscal Report Center: 07
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 92 76.250000 2821.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 67 212.500000 18.5000 0.0871
TCM-T1017TL-TARGETED CASE MANAGEMENT 44 181.000000 6687.7500 36.9489
Subtotal (Total Children Is Unduplicated) 115 469.750000 9527.5000 20.2821
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 35.500000 1970.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 32.000000 2400.0000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 27 75.000000 4907.7500 65.4367
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 21 30.000000 300.0000 10.0000
TRAV-TRAVS-Travel by mile 3 34.000000 15.1400 0.4453
Subtotal (Total Children Is Unduplicated) 21 64.000000 315.1400 4.9241
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Total 608.750000 14750.3900 24.2306
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Number of Children (Unduplicated) With at Least One Service 116
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Center 07
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 41 77.500000 1191.1400 1191.1400
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
527 531.250000 13559.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 568 608.750000 14750.3900 1191.1400