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
Agency Filter:EIP DEI DEIP
Payclass Filters:TPIN
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 5 4.750000 175.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 54 119.250000 4421.5000 37.0776
Subtotal (Total Children Is Unduplicated) 54 125.250000 4597.2500 36.7046
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.000000 1125.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 25.213300 1891.0000 75.0001
Subtotal (Total Children Is Unduplicated) 17 40.213300 3016.0000 75.0001
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Total 165.463300 7613.2500 46.0117
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Number of Children (Unduplicated) With at Least One Service 69
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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 4 3.713300 278.5000 278.5000
D 1 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 17 32.500000 2437.5000 0.0000
T 0 0.000000 0.0000 0.0000
160 127.250000 4747.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 182 165.463300 7613.2500 278.5000