CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 48 48.750000 1803.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 37 38.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 14 34.750000 1285.7500 37.0000
Subtotal (Total Children Is Unduplicated) 48 121.500000 3089.5000 25.4280
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 13.500000 749.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.500000 712.5000 75.0000
Subtotal (Total Children Is Unduplicated) 12 32.500000 2174.2500 66.9000
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 3.500000 175.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
TRAV-TRAVS-Travel by mile 31 2011.000000 894.7800 0.4449
Subtotal (Total Children Is Unduplicated) 32 2015.500000 1079.7800 0.5357
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Total 2169.500000 6343.5300 2.9240
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Number of Children (Unduplicated) With at Least One Service 49
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Center 02
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 39 1039.000000 1846.2100 1846.2100
0 0.000000 0.0000 0.0000
Other 263 1130.500000 4497.3200 0.0000
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Total 302 2169.500000 6343.5300 1846.2100