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
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 938 730.000000 26973.0000 36.9493
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 483 1202.500000 92.5000 0.0769
TCM-T1017TL-TARGETED CASE MANAGEMENT 421 1502.250000 55047.2500 36.6432
Subtotal (Total Children Is Unduplicated) 1194 3434.750000 82112.7500 23.9065
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 34 54.250000 2712.5000 50.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 51 190.000000 10545.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 83.000000 6225.0000 75.0000
Subtotal (Total Children Is Unduplicated) 100 327.250000 19482.5000 59.5340
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EI Services,Class #03
CONIF-CONIF-CONSULT, FACE TO FACE 6 7.000000 350.0000 50.0000
CONIP-CONIP-CONSULT, PHONE 1 0.500000 12.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 5.250000 262.5000 50.0000
TRAV-TRAVS-Travel by mile 1 21.000000 9.3450 0.4450
Subtotal (Total Children Is Unduplicated) 12 33.750000 634.3450 18.7954
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Total 3795.750000 102229.5950 26.9326
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Number of Children (Unduplicated) With at Least One Service 1194
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2 4.000000 300.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4867 3791.750000 101929.5950 543.0000
Other 0 0.000000 0.0000 0.0000
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Total 4869 3795.750000 102229.5950 543.0000