CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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 33 31.000000 1147.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 21 22.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 21 74.750000 2765.7500 37.0000
Subtotal (Total Children Is Unduplicated) 40 127.750000 3912.7500 30.6282
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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-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 3 5.500000 412.5000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 18 41.000000 2523.5000 61.5488
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 7 12.250000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 17 21.000000 210.0000 10.0000
Subtotal (Total Children Is Unduplicated) 22 33.250000 210.0000 6.3158
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Total 202.000000 6646.2500 32.9022
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Number of Children (Unduplicated) With at Least One Service 41
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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 27 32.000000 859.5000 859.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
178 168.000000 5636.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 206 202.000000 6646.2500 859.5000