CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 47 42.750000 1581.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 36 31.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 30 126.250000 4671.2500 37.0000
Subtotal (Total Children Is Unduplicated) 52 200.500000 6253.0000 31.1870
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
Subtotal (Total Children Is Unduplicated) 1 3.000000 195.7500 65.2500
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 2.000000 130.0000 65.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 2.000000 20.0000 10.0000
Subtotal (Total Children Is Unduplicated) 2 4.000000 150.0000 37.5000
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Total 207.500000 6598.7500 31.8012
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Number of Children (Unduplicated) With at Least One Service 52
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Center 06
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
294 207.500000 6598.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 294 207.500000 6598.7500 0.0000