CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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 83 95.750000 3542.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 69 38.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 62 179.250000 6632.2500 37.0000
Subtotal (Total Children Is Unduplicated) 123 313.000000 10175.0000 32.5080
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.000000 95.0000 47.5000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.500000 187.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 19.500000 1054.5800 54.0810
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 8.500000 572.5000 67.3529
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 23 31.000000 2312.7700 74.6055
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 11.500000 545.0000 47.3913
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 30.500000 2199.8900 72.1275
Subtotal (Total Children Is Unduplicated) 51 105.500000 6967.2400 66.0402
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EI Services,Class #03
INTR-T1013-INTERPRETER 5 6.000000 300.0000 50.0000
TRAV-TRAVS-Travel by mile 1 46.000000 20.4700 0.4450
Subtotal (Total Children Is Unduplicated) 6 52.000000 320.4700 6.1629
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Total 470.500000 17462.7100 37.1152
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Number of Children (Unduplicated) With at Least One Service 126
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Center 09
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 352 427.250000 15184.6300 15184.6300
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
34 43.250000 2278.0800 112.5000
Other 0 0.000000 0.0000 0.0000
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Total 386 470.500000 17462.7100 15297.1300