Monthly Reimbursement Request Instructions Texas
This document provides detailed instructions for submitting a monthly reimbursement request using the State of Texas Purchase Voucher. It includes guidelines on filling out the form correctly to avoid delays. This form is essential for agencies seeking reimbursement from the Texas Department of State Health Services.
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How do I fill this out?
Filling out this form requires careful attention to detail. Begin by gathering all necessary information about your agency and the services provided. Ensure that your entries are accurate to facilitate swift processing.
How to fill out the Monthly Reimbursement Request Instructions Texas?
1
Review the form layout and instructions provided.
2
Gather all necessary documentation and payment information.
3
Complete each section accurately according to the guidelines.
4
Double-check the form for any inaccuracies or missing information.
5
Submit the completed form to the appropriate department.
Who needs the Monthly Reimbursement Request Instructions Texas?
1
State agencies needing to submit reimbursement requests.
2
Non-profit organizations that provide services funded by DSHS.
3
For-profit entities contracted to provide health services.
4
Colleges and universities providing student health services.
5
Accounting departments needing to track reimbursement submissions.
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What are the instructions for submitting this form?
Instructions for submitting this form include sending it via mail to the Accounts Payable - Grants, Texas Department of State Health Services, 1100 West 49th Street, Austin, Texas 78756-3199. You may also submit the form through fax at (512) 458-7704. Ensure that you keep a copy of the submission for your records.
What are the important dates for this form in 2024 and 2025?
Important dates related to the reimbursement form include submission deadlines tied to monthly billing cycles. Ensure that all requests are submitted promptly by the last day of each month. Check back frequently for any updates or changes to submission policies in 2024 and 2025.
What is the purpose of this form?
The purpose of this form is to facilitate the reimbursement process for services rendered under contract with the Texas Department of State Health Services. It ensures that agencies receive timely payment for services provided. Complete and accurate submissions help maintain transparency and efficiency in the reimbursement process.
Tell me about this form and its components and fields line-by-line.
- 1. Order Date: The date on which the voucher is submitted for payment.
- 2. Payee I.D. No.: The 14 digit code assigned to your agency by the State Comptroller.
- 3. Document Amount: The total net amount being billed to DSHS for the indicated period.
- 4. Payee Name/Address: The official name and contact address of the Performing Agency.
- 5. Ser/Del Date: The month in which costs were incurred or paid.
- 6. Description of Goods or Services: A detailed description of the services or goods provided.
- 7. Contract Number: The contract number assigned by DSHS.
- 8. Contact Name: The name and phone number of the responsible account person.
What happens if I fail to submit this form?
Failing to submit this form could result in delayed payments or complete denial of reimbursement. It is crucial to ensure that all required fields are accurately filled to avoid complications. Always check your submission against the guidelines to ensure compliance.
- Payment Delays: Failure to submit correctly can result in significant delays in receiving your funds.
- Reimbursement Denied: Inaccurate submissions may lead to full denial of your reimbursement request.
- Request for Additional Information: Incorrectly submitted forms may prompt requests for further clarification or details.
How do I know when to use this form?
- 1. Reimbursement for Services: Use this form to request reimbursement for health services provided over the contract period.
- 2. Monthly Billing Submissions: This form is required for monthly submissions related to services rendered.
- 3. Contract Compliance: Agencies must use this form to comply with contract stipulations regarding reimbursements.
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What happens if I submit the form incorrectly?
If submitted incorrectly, the reimbursement request may face delays due to the need for additional information.
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