CMS/EIP Fiscal Report Statewide
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 770 750.750000 27777.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 770 1089.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 578 2145.000000 79346.5000 36.9914
Subtotal (Total Children Is Unduplicated) 1283 3985.500000 107124.2500 26.8785
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 39 86.143000 4307.1500 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.000000 95.0000 47.5000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 11.000000 795.1200 72.2836
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 14.000000 777.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 159 237.978165 17278.3499 72.6048
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 54 78.388800 5814.1500 74.1707
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 56 74.637500 5528.6600 74.0735
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 201 264.500000 14586.5000 55.1474
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 111 164.500000 12249.8900 74.4674
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 9 9.000000 416.7000 46.3000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 400 950.147465 62398.5199 65.6725
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 0.500000 25.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 6.500000 325.0000 50.0000
INTR-T1013-INTERPRETER 28 49.250000 2434.0000 49.4213
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 252 486.000000 4583.6100 9.4313
PHY-97110-PT SESSION BY LICENSED PT 1 1.750000 125.0200 71.4400
TRAV-TRAVS-Travel by mile 199 6292.000000 2738.4400 0.4352
Subtotal (Total Children Is Unduplicated) 358 6838.000000 10331.0700 1.5108
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Total 11773.647465 179853.8399 15.2760
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Number of Children (Unduplicated) With at Least One Service 1333
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 70 859.250000 2707.6000 2707.6000
D 6 62.000000 451.9800 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4 38.000000 124.8500 124.8500
418 325.500000 9553.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 498 1284.750000 12837.9300 2832.4500
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 35 412.000000 1238.0400 1241.0400
4 68.500000 300.9800 0.0000
Other 245 1426.500000 3804.9500 0.0000
---------------------------------------------------------
Total 284 1907.000000 5343.9700 1241.0400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
549 465.750000 20772.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 549 465.750000 20772.2700 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 13.000000 130.0000 130.0000
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
317 363.500000 15521.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 320 376.500000 15651.9500 130.0000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 112 1019.000000 4511.6200 4511.6200
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
276 182.000000 4810.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 388 1201.000000 9321.6200 4511.6200
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 2 4.000000 234.0000 234.0000
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
414 268.000000 8962.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 416 272.000000 9196.5000 234.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 60 130.000000 1848.7300 1848.7300
D 1 2.250000 83.2500 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
727 671.500000 18431.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 788 803.750000 20363.4800 1848.7300
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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
---------------------------------------------------------
Total 386 470.500000 17462.7100 15297.1300
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
294 304.750000 10750.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 294 304.750000 10750.5000 0.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 16 16.000000 726.0000 726.0000
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
201 155.500000 5342.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 217 171.500000 6068.2500 726.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 77 1099.500000 1275.4600 1224.4600
150 126.000000 2606.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 227 1225.500000 3881.4600 1224.4600
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
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
---------------------------------------------------------
Total 579 856.500000 8662.7500 1412.8400
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 99 746.500000 1460.7200 1460.7200
715 764.000000 11153.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 814 1510.500000 12613.9200 1460.7200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 22 36.652300 2327.9100 2327.9100
D 7 14.000000 1050.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 15 29.637500 2105.8100 2105.8100
405 354.107665 12704.4999 4178.3000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 449 434.397465 18188.2199 8612.0200
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 8 296.000000 189.0600 189.0600
164 193.250000 8549.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 172 489.250000 8738.3100 189.0600