CMS/EIP Fiscal Report Center: 53
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 55 79.000000 2923.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 72 151.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 24 93.250000 3450.2500 37.0000
Subtotal (Total Children Is Unduplicated) 76 323.500000 6373.2500 19.7009
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 3 6.000000 300.0000 50.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.000000 222.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 7.000000 525.0000 75.0000
Subtotal (Total Children Is Unduplicated) 9 17.000000 1047.0000 61.5882
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 62 106.000000 1060.0000 10.0000
TRAV-TRAVS-Travel by mile 14 410.000000 182.5000 0.4451
Subtotal (Total Children Is Unduplicated) 62 516.000000 1242.5000 2.4079
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Total 856.500000 8662.7500 10.1141
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Number of Children (Unduplicated) With at Least One Service 76
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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 0 0.000000 0.0000 0.0000
T 17 217.000000 182.5900 182.5900
562 639.500000 8480.1600 1230.2500
Other 0 0.000000 0.0000 0.0000
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Total 579 856.500000 8662.7500 1412.8400