CMS/EIP Fiscal Report Center: 07
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 113 86.250000 3191.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 92 278.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 41 174.000000 6438.0000 37.0000
Subtotal (Total Children Is Unduplicated) 138 538.250000 9629.2500 17.8899
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.500000 179.6500 71.8600
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 22 41.000000 2275.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 46.000000 3450.0000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 31 101.500000 6741.1500 66.4153
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 3.000000 250.0000 83.3333
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 26 35.000000 350.0000 10.0000
TRAV-TRAVS-Travel by mile 1 24.000000 10.6800 0.4450
Subtotal (Total Children Is Unduplicated) 26 62.000000 610.6800 9.8497
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Total 701.750000 16981.0800 24.1982
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Number of Children (Unduplicated) With at Least One Service 140
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Center 07
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 45 71.500000 1286.0800 1286.0800
D 11 12.000000 444.0000 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
648 618.250000 15251.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 704 701.750000 16981.0800 1286.0800