CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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 1549 989.000000 36593.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 866 637.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 870 2209.750000 81760.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1948 3836.250000 118353.7500 30.8514
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.500000 75.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 46.000000 3450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 17.000000 1275.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 18.500000 1387.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 42.500000 2358.7500 55.5000
Subtotal (Total Children Is Unduplicated) 39 125.500000 8546.2500 68.0976
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Total 3961.750000 126900.0000 32.0313
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Number of Children (Unduplicated) With at Least One Service 1948
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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
7302 3961.750000 126900.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7302 3961.750000 126900.0000 0.0000