CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 718 484.000000 17908.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 399 357.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 409 1077.750000 39876.7500 37.0000
Subtotal (Total Children Is Unduplicated) 955 1919.500000 57784.7500 30.1041
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Screening, Eval, and Assessment,Class #02
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 2 2.000000 100.0000 50.0000
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
Subtotal (Total Children Is Unduplicated) 2 3.000000 171.4400 57.1467
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Total 1924.500000 58056.1900 30.1669
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Number of Children (Unduplicated) With at Least One Service 956
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Center 03
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 0 0.000000 0.0000 0.0000
3893 1924.500000 58056.1900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3893 1924.500000 58056.1900 0.0000