CMS/EIP Fiscal Report Center: 54
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 35.750000 1322.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 130 248.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 43 174.000000 6438.0000 37.0000
Subtotal (Total Children Is Unduplicated) 135 458.250000 7760.7500 16.9356
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 15.500000 1162.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 33.500000 1859.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 14.500000 1087.5000 75.0000
Subtotal (Total Children Is Unduplicated) 26 73.000000 4821.7500 66.0514
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 120 226.000000 2260.0000 10.0000
TRAV-TRAVS-Travel by mile 61 1163.000000 517.6600 0.4451
Subtotal (Total Children Is Unduplicated) 120 1389.000000 2777.6600 1.9998
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Total 1920.250000 15360.1600 7.9990
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Number of Children (Unduplicated) With at Least One Service 136
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Center 54
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 74 541.500000 1562.0500 1562.0500
T 79 646.000000 1690.7400 1690.7400
780 732.750000 12107.3700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 933 1920.250000 15360.1600 3252.7900