SERVICE REPORTING REQUIREMENTS. On request, the Provider shall supply copies of documents from the State of Illinois reflecting services that have been presented to the State of Illinois for payment, fee for service contracts or grant funding agreements held with any State Department, with all applicable exhibits or attachments, when funded services fall under 59 Illinois Administrative Code, Part 115, Part 119, Part 120, Part 132, Part 140, and 77 Illinois Administrative Code Part 2060 and Part 2090 in order to coordinate benefits and Network service capacity. The Provider shall provide reports in either paper or electronic format acceptable to the Mental Health Board. Mental Health Board billing affidavits shall be accompanied by the submission of data as specified in the approved Mental Health Board Work Plan to substantiate the payment request, as well as all other financial and billing documentation reasonably requested by the Mental Health Board. Failure of Provider to submit the requested information to the Mental Health Board will be considered a breach of this Agreement. All information submitted by the Provider shall comply with the confidentiality requirements of state and federal law.
SERVICE REPORTING REQUIREMENTS. The Provider shall submit monthly service reports indicating the actual units of service provided. These reports are due to DDSN as outlined in the DDSN Finance Manual.
SERVICE REPORTING REQUIREMENTS. On request, the Provider shall provide copies of documents from the Department of Human Services reflecting clinical services that have been presented to the Department of Human Services for payment when such services fall under 59 Illinois Administrative Code, Part 132 in order to coordinate billing and service capacity. The Provider shall provide reports in either paper or electronic format acceptable to the Mental Health Board for Service planning purposes. Billing affidavits shall be accompanied by the electronic submission of Service lines and shall include demographic and Service data as specified in the approved Work Plan to substantiate the payment request, as well as all other financial and billing documentation reasonably requested by the Mental Health Board. Failure of Provider to submit the information requested to the Mental Health Board in a timely manner will be considered a breach of this Agreement. All information submitted by the Provider shall comply with the confidentiality requirements of state and federal law.
SERVICE REPORTING REQUIREMENTS. Jurisdictional factors shall be developed and reported for particular services as specified in the BellSouth Tariffs and as specified in applicable contracts that are provisioned for a carrier. Factor reporting requirements for these services are discussed in the following subsections.
SERVICE REPORTING REQUIREMENTS. On request, the Provider shall provide reports in either paper or electronic format acceptable by the WCCMHB. WCCMHB billing affidavits shall be accompanied by the submission of data as specified in the WCCMHB Work Plan to substantiate the payment request, as well as all other financial and billing documentation as reasonably DRAFT requested by the WCCMHB. Failure of Provider to submit requested information to the WCCMHB shall be considered a breach of this Agreement. All information submitted by the Provider shall comply with the confidentiality requirements of state and federal law.
