CMS/EIP Fiscal Report Center: 52
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 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 86 35.000000 1292.1500 36.9186
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 9 6.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 101 477.500000 17683.3500 37.0332
Subtotal (Total Children Is Unduplicated) 146 518.500000 18975.5000 36.5969
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 315.6000 31.5600
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 250.0000 62.5000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.000000 999.0000 55.5000
Subtotal (Total Children Is Unduplicated) 14 36.000000 1864.6000 51.7944
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 21 11.000000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 3.000000 30.0000 10.0000
TRAV-TRAVS-Travel by mile 107 1801.000000 801.1900 0.4449
Subtotal (Total Children Is Unduplicated) 110 1815.000000 831.1900 0.4580
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Total 2369.500000 21671.2900 9.1459
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Number of Children (Unduplicated) With at Least One Service 178
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Center 52
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 1 2.000000 111.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 5 11.250000 603.2500 0.0000
S 1 2.000000 74.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 134 1820.000000 1546.7900 1217.1900
567 534.250000 19336.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 708 2369.500000 21671.2900 1217.1900