Billing Instructions. Enter name and mailing address of nominating Agency Finance Office for billing purposes.
Billing Instructions. 4.1 Grantee shall bill System Agency monthly for allowable services provided to Title V eligible Clients per the Policy Manual.
4.2 At the request of HHSC, Grantee may be required to provide additional supportive documentation of invoices.
Billing Instructions. 1. Invoices shall be submitted electronically in one (1) continuous electronic copy in PDF to xxxxxx@xxx.xxx. The VRE Project Manager shall be copied on the email.
2. The VRE Project Manager shall be indicated on the invoice cover sheet.
3. At a minimum, invoices shall contain the following information:
a. Name, address and telephone number of Contractor
b. VRE Purchase Order number
c. Contractor’s invoice number
d. Sequential invoice number for the project, if applicable
e. Date of invoice
f. Period of invoice
g. Summary description of work performed, or items delivered
h. Percentage of the scope of work complete
i. Percentage of the budget complete
j. Breakdown of invoice amount by Prime Contractor and Subcontractor
k. Total invoice amount
l. Total cumulative amount invoiced
m. Contractor’s signature
4. If invoices fail to meet all of the above requirements, they will not be processed for payment and will result in the invoice being returned to the Contractor for correction and resubmission. VRE may request additional substantiating documentation as necessary.
Billing Instructions. A. Grantee will submit all invoices to System Agency through CMBHS monthly.
B. Grantee may access the Transactions List report in CMBHS to identify the amount of federal funds allocated to this award for each transaction.
C. The CFDA number for the State Targeted Response to the Opioid Crisis Grant is 93.788.
D. The CFDA number is identified in the CMBHS Transactions List report.
Billing Instructions. Grantee shall submit requests for reimbursement for services provided with Program funds on a Form 4116 monthly within 30 days following the end of the month covered by the bill. Grantee shall submit a reimbursement request as a final close-out bill not later than 45 days following the end of the applicable Grantee term(s) for costs encumbered on or before the last day of the Contract term. Reimbursement requests received in HHSC offices more than 45 days following the end of the applicable Contract period will not be paid. Grantee shall submit a Form 4116 to the OPSH Analysis and Decision Support Team and the Program using the email addresses on the Form 4116 instructions. Grantee shall submit Form 4116 each month for actual program expenditures, even if there are Exhibit C, Epilepsy Contract HHS0007015 RFA Epilepsy Grant Program zero expenditures or if the contract budget limit has been reached. Grantee shall accept reimbursement or payment from HHSC and any applicable fees from clients for clinical services as payment in full for services or goods provided to clients. Grantee shall not seek additional reimbursement or payment for services or goods from clients other than applicable fees for clinical health services. HHSC shall distribute funds to maximize the delivery of authorized services to eligible clients. HHSC will monitor Xxxxxxx’s billing activity. Grantee may be subject to Contract amount decreases if Grantee’s billing activity is less than projected. Funds made available in the Contract year shall be used only for services performed during the same Contract year. Funds that are not expended for services during that Contract year cannot be used for services in any other period.
Billing Instructions. 4.1 Grantee shall bill System Agency on a monthly basis for allowable services provided to Title V eligible clients. Bills for all allowable services shall be submitted as aggregate activity reports with a System Agency Monthly Reimbursement Request and shall not refer to or identify individual clients. Grantee shall bill within thirty (30) days after the end of the month in which services were provided or within sixty (60) days in cases of potentially Medicaid eligible individuals who are denied eligibility by the Health and Human Services Commission. All bills shall be submitted within forty-five (45) days of the end of the Contract term.
4.2 Grantee shall request payment using the Purchase Voucher Form 4116 which coincides with the appropriate Monthly Reimbursement Request (MRR), for Title V Fee for Service Program (Form #EF21-12005). With each Purchase Voucher Form 4116 and MRR, Grantee shall submit the following acceptable supporting documentation for reimbursement of the required services/deliverables:
1. Title V Maternal-Child Services Report (Child Health & Dental) – (Form EF21-12005); and
2. Monthly Aggregate Activity Report (Form EF21-12005). Each report shall detail the total unduplicated number of clients seen for the first time within a service category type during the contract period by age, and race/ethnicity. Billing requests will not be processed for payment by System Agency unless accompanied by a complete corresponding aggregate report.
4.3 Grantee shall submit Purchase Vouchers, MRRs, and supporting documentation to the email address(es) listed on the purchase voucher and MRR. Purchase Vouchers and MRRs shall be submitted each month for actual expenditures of the program, even if there are zero monthly expenditures or the contract limit has been reached.
4.4 Grantee shall request payment from System Agency as directed by the Title V Maternal and Child Health Fee for Service Program Policy Manual whether via voucher or a web-based system.
4.5 Grantee shall submit a “Financial Reconciliation Report” (Form GC-10) no later than sixty (60) days after the end of the attachment term. This report must be signed and marked “Final” and shall be scanned and emailed to email address(es) listed on the Form GC-10.
4.6 System Agency shall distribute funds in a way that will maximize the delivery of authorized services to eligible clients. System Agency will monitor Xxxxxxx's billing activity. If utilization is below that projected in Grantee's budget,...
Billing Instructions. A. Grantee shall request payment using the State of Texas Purchase Voucher (Form B-13) and acceptable supporting documentation for reimbursement of the required services/deliverables. Vouchers and supporting documentation should be mailed or submitted by fax or electronic mail to the addresses/number below. Department of State Health Services Claims Processing Unit, MC1940 0000 Xxxx 00xx Xxxxxx PO Box 149347 Austin, TX 00000-0000 FAX: (000) 000-0000 EMAIL: xxxxxxxx@xxxx.xxxxx.xxx xxxxxxxxxxx@xxxx.xxxxx.xxx
B. Grantee will be paid on a cost reimbursement basis and in accordance with the Budget in Attachment B-2 of the Contract.
Billing Instructions. 1. Grantee shall submit all invoices to the System Agency through CMBHS monthly.
2. Grantee shall be paid on a monthly basis and in accordance with services performed under this Contract.
3. All invoices must reference Purchase Order Number.
Billing Instructions. DSHS will make payments for services it receives under this Contract to the Contractor from its current revenues.
Billing Instructions. The Contractor will provide an invoice on the Contractor’s letterhead for services rendered. Each invoice will have a number and will include the following information:
1. Contractor’s name and address
2. Contractor’s remittance address, if different from 1, above
3. Name of County agency/department
4. Agency/department address
5. Contract Number – MA-012-21010015
6. Federal Tax I.D. Number
7. Date of service 8. Service description
