CMS/EIP Fiscal Report Center: 53
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 72 71.000000 2590.0000 36.4789
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 87 183.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 19 82.250000 3043.2500 37.0000
Subtotal (Total Children Is Unduplicated) 91 336.250000 5633.2500 16.7532
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 7 14.000000 923.2500 65.9464
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.500000 75.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 74 144.000000 1440.0000 10.0000
TRAV-TRAVS-Travel by mile 28 681.000000 303.1300 0.4451
Subtotal (Total Children Is Unduplicated) 74 827.500000 1868.1300 2.2576
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Total 1177.750000 8424.6300 7.1532
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Number of Children (Unduplicated) With at Least One Service 91
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Center 53
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 35 206.000000 482.4600 482.4600
T 31 327.500000 410.5000 410.5000
594 644.250000 7531.6700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 660 1177.750000 8424.6300 892.9600