CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 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 60 49.500000 1831.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 44 39.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 34 135.000000 4995.0000 37.0000
Subtotal (Total Children Is Unduplicated) 63 224.000000 6826.5000 30.4754
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
Subtotal (Total Children Is Unduplicated) 4 12.000000 841.5000 70.1250
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EI Services,Class #03
INTR-T1013-INTERPRETER 4 8.000000 494.0000 61.7500
Subtotal (Total Children Is Unduplicated) 4 8.000000 494.0000 61.7500
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Total 244.000000 8162.0000 33.4508
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Number of Children (Unduplicated) With at Least One Service 63
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Center 06
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 3 6.000000 377.0000 377.0000
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 0 0.000000 0.0000 0.0000
341 238.000000 7785.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 344 244.000000 8162.0000 377.0000