CMS/EIP Fiscal Report Center: 07
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 50 54.250000 2007.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 40 34.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 21 79.000000 2923.0000 37.0000
Subtotal (Total Children Is Unduplicated) 56 167.500000 4930.2500 29.4343
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Screening, Eval, and Assessment,Class #02
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 4 8.000000 560.0000 70.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 27.000000 1498.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
Subtotal (Total Children Is Unduplicated) 17 45.000000 2769.5000 61.5444
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 11 11.000000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 14 20.000000 200.0000 10.0000
Subtotal (Total Children Is Unduplicated) 23 31.000000 200.0000 6.4516
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Total 243.500000 7899.7500 32.4425
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Number of Children (Unduplicated) With at Least One Service 64
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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 24 27.000000 626.5000 626.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 10.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
270 206.500000 6523.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 299 243.500000 7899.7500 626.5000