CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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 55 62.750000 2321.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 34 31.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 22 74.750000 2738.0000 36.6288
Subtotal (Total Children Is Unduplicated) 61 169.000000 5059.7500 29.9393
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 27.500000 1526.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 18.700000 1402.5000 75.0000
Subtotal (Total Children Is Unduplicated) 20 60.200000 3939.7500 65.4444
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 11 15.750000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 19 30.000000 300.0000 10.0000
TRAV-TRAVS-Travel by mile 1 26.000000 11.5700 0.4450
Subtotal (Total Children Is Unduplicated) 27 71.750000 311.5700 4.3424
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Total 300.950000 9311.0700 30.9389
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Number of Children (Unduplicated) With at Least One Service 63
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Center 07
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 35 63.000000 729.3200 729.3200
D 6 8.500000 427.5000 0.0000
S 4 4.500000 138.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
296 224.950000 8015.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 341 300.950000 9311.0700 729.3200