CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2016 ending 06/30/2016 Date of Report:08/06/2016 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 53 51.500000 1905.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 77 245.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 25 110.250000 4079.2500 37.0000
Subtotal (Total Children Is Unduplicated) 83 407.500000 5984.7500 14.6865
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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-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 16.000000 888.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 16.500000 1237.5000 75.0000
Subtotal (Total Children Is Unduplicated) 16 34.000000 2238.0000 65.8235
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
INTR-T1013-INTERPRETER 1 2.000000 140.0000 70.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 70 136.000000 1360.0000 10.0000
TRAV-TRAVS-Travel by mile 23 673.000000 299.5600 0.4451
Subtotal (Total Children Is Unduplicated) 70 812.000000 1849.5600 2.2778
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Total 1253.500000 10072.3100 8.0353
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Number of Children (Unduplicated) With at Least One Service 83
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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 75 729.000000 1974.0600 1974.0600
T 184 166.750000 2966.2500 2966.2500
371 357.750000 5132.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 630 1253.500000 10072.3100 4940.3100