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: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 41 67.000000 2479.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 40 63.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 14 38.000000 1406.0000 37.0000
Subtotal (Total Children Is Unduplicated) 45 168.000000 3885.0000 23.1250
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.500000 825.0000 66.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 18.500000 1026.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
Subtotal (Total Children Is Unduplicated) 11 39.000000 2451.7500 62.8654
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EI Services,Class #03
INTR-T1013-INTERPRETER 4 16.000000 800.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 6 14.000000 63.5600 4.5400
TRAV-TRAVS-Travel by mile 25 1747.000000 777.4700 0.4450
Subtotal (Total Children Is Unduplicated) 25 1777.000000 1641.0300 0.9235
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Total 1984.000000 7977.7800 4.0211
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Number of Children (Unduplicated) With at Least One Service 45
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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 67 1682.000000 3537.6500 2745.3600
0 0.000000 0.0000 0.0000
Other 257 302.000000 4440.1300 0.0000
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Total 324 1984.000000 7977.7800 2745.3600