CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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 83 127.500000 4717.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 63 43.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 64 227.250000 8408.2500 37.0000
Subtotal (Total Children Is Unduplicated) 124 397.750000 13125.7500 33.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 22 36.500000 2737.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 14.000000 777.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 7.500000 562.5000 75.0000
Subtotal (Total Children Is Unduplicated) 30 64.500000 4564.5000 70.7674
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 8 9.000000 0.0000 0.0000
INTR-T1013-INTERPRETER 11 16.750000 823.5000 49.1642
TRAV-TRAVS-Travel by mile 10 471.000000 209.6100 0.4450
Subtotal (Total Children Is Unduplicated) 24 496.750000 1033.1100 2.0797
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Total 959.000000 18723.3600 19.5238
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Number of Children (Unduplicated) With at Least One Service 129
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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 384 947.000000 18027.8600 18027.8600
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
6 8.500000 472.0000 0.0000
Other 2 3.500000 223.5000 0.0000
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Total 392 959.000000 18723.3600 18027.8600