CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 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 105 133.750000 4948.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 19 20.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 44 122.500000 4532.5000 37.0000
Subtotal (Total Children Is Unduplicated) 113 277.000000 9481.2500 34.2283
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 212.5000 53.1250
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 30.000000 1665.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 22.000000 1221.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.830900 662.3175 75.0000
Subtotal (Total Children Is Unduplicated) 30 70.830900 4093.8175 57.7971
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 12 23.500000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 24 36.000000 360.0000 10.0000
Subtotal (Total Children Is Unduplicated) 36 59.500000 360.0000 6.0504
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Total 407.330900 13935.0675 34.2107
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Number of Children (Unduplicated) With at Least One Service 117
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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 40 48.000000 1016.5000 1016.5000
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
465 357.080900 12835.3175 0.0000
Other 1 2.250000 83.2500 0.0000
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Total 506 407.330900 13935.0675 1016.5000