CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:DEI Only
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1 0.750000 27.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 1.500000 0.0000 0.0000
Subtotal (Total Children Is Unduplicated) 1 2.250000 27.7500 12.3333
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EI Services,Class #03
TRAV-TRAVS-Travel by mile 1 115.000000 51.1800 0.4450
Subtotal (Total Children Is Unduplicated) 1 115.000000 51.1800 0.4450
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Total 117.250000 78.9300 0.6732
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Number of Children (Unduplicated) With at Least One Service 1
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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 2 115.000000 51.1800 51.1800
0 0.000000 0.0000 0.0000
Other 5 2.250000 27.7500 0.0000
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Total 7 117.250000 78.9300 51.1800