CMS/EIP Fiscal Report Center: 06
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 69 48.000000 1776.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 16 11.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 44 131.000000 4847.0000 37.0000
Subtotal (Total Children Is Unduplicated) 76 190.750000 6623.0000 34.7208
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 2 4.000000 261.0000 65.2500
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 2.000000 160.0000 80.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 6.000000 60.0000 10.0000
Subtotal (Total Children Is Unduplicated) 3 8.000000 220.0000 27.5000
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Total 202.750000 7104.0000 35.0382
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Number of Children (Unduplicated) With at Least One Service 77
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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 7 8.000000 220.0000 220.0000
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
306 194.750000 6884.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 313 202.750000 7104.0000 220.0000