CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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 21 9.000000 333.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 37 41.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 52 133.750000 4948.7500 37.0000
Subtotal (Total Children Is Unduplicated) 80 184.500000 5281.7500 28.6274
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 412.5000 68.7500
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 17.000000 860.2500 50.6029
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
Subtotal (Total Children Is Unduplicated) 10 27.500000 1610.2500 58.5545
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EI Services,Class #03
INTR-T1013-INTERPRETER 7 13.500000 662.5000 49.0741
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 4.000000 40.0000 10.0000
TRAV-TRAVS-Travel by mile 17 565.000000 242.4700 0.4292
Subtotal (Total Children Is Unduplicated) 19 582.500000 944.9700 1.6223
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Total 794.500000 7836.9700 9.8640
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Number of Children (Unduplicated) With at Least One Service 87
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Center 01
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 45 554.250000 1957.6900 1957.6900
D 5 9.500000 107.1400 0.0000
S 3 38.000000 15.6400 0.0000
H 0 0.000000 0.0000 0.0000
T 2 3.750000 195.7500 183.2500
248 189.000000 5560.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 303 794.500000 7836.9700 2140.9400