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{"sheet":"Contract Invoice","index":0,"n_rows":34,"n_cols":29,"rows_kept":34,"cut":false,"hidden":false,"merged":[[12,8,12,10],[12,2,12,5],[17,0,17,4],[17,6,17,8],[15,0,15,4],[16,6,16,8],[8,0,9,1],[16,0,16,4],[2,0,2,14],[0,5,0,8],[10,8,10,10],[5,3,5,7],[8,2,8,5],[6,2,6,5],[4,2,4,5],[4,8,4,10],[6,8,6,10],[8,8,8,10],[7,3,7,7],[10,6,10,7],[15,6,15,8],[13,3,13,7],[18,6,18,8],[25,3,25,4],[25,6,25,7],[20,3,20,4],[18,0,18,4],[33,3,33,4],[33,6,33,7],[27,3,27,4],[27,6,27,7],[29,3,29,4],[29,6,29,7],[31,3,31,4],[31,6,31,7]]}
[null,null,null,null,null,"DHS Contract Invoice",null,null,null,null,null,null,null,null,"CF0846\n(02/2015)"," "]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Provider number:",null,null,null,null,null,null,"Contact email:",null,null,null,null,null,null,null," "]
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["Provider name:",null,null,null,null,null,null,"Invoice number:",null,null,null,null,null,null,null," "]
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[null,null,"(Street, City, State, ZIP)",null,null,null,"Billing month/year:",null,null,null,null,null,null,null,null," "]
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{"sheet":"One Twelfth Payments","index":1,"n_rows":34,"n_cols":27,"rows_kept":34,"cut":false,"hidden":false,"merged":[[0,5,0,8],[2,1,2,12],[8,0,8,1],[4,9,4,10],[6,9,6,10],[8,9,8,10],[18,6,18,8],[15,0,15,4],[17,0,17,4],[15,6,15,8],[17,6,17,8],[16,6,16,8],[16,0,16,4],[10,9,10,10],[12,9,12,10],[4,2,4,6],[6,2,6,6],[8,2,8,6],[12,2,12,6],[27,3,27,4],[29,3,29,4],[31,3,31,4],[33,3,33,4],[18,0,18,4],[25,3,25,4],[20,0,20,2],[20,3,20,4]]}
[null,null,null,null,null,"DHS Contract Invoice \nfor Regular 1/12th Monthly Payments",null,null,null,null,null,null,"CF0846\n(02/2015)"," "]
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[null,null,"(Street, City, State, ZIP)",null,null,null,null,null,"Billing month/year:",{"$f":"'Contract Invoice'!I11","v":"00:00:00"},null,null,null," "]
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[null,"1/12th Invoice",null,null,null,null,null,null,null,null,null,null,null," "]
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{"sheet":"Invoice Instructions","index":2,"n_rows":56,"n_cols":3,"rows_kept":56,"cut":false,"hidden":false,"merged":[[54,0,54,1],[55,0,55,1],[17,0,17,1],[7,1,7,2],[12,0,12,1],[13,0,13,1],[14,0,14,1],[15,0,15,1],[16,0,16,1],[9,1,9,2],[10,0,10,2],[18,0,18,1],[19,0,19,1],[23,0,23,1],[24,0,24,1],[25,0,25,1],[0,0,0,2],[11,0,11,1],[4,1,4,2],[3,1,3,2],[22,0,22,1],[20,0,21,1],[26,0,26,1],[27,0,27,1],[28,0,28,1],[29,0,29,1],[30,0,30,1],[31,0,31,1],[32,0,32,1],[33,0,33,1],[34,0,34,1],[35,0,35,1],[36,0,36,1],[37,0,37,1],[38,0,38,1],[39,0,39,1],[40,0,40,1],[41,0,41,1],[42,0,42,1],[43,0,43,1],[44,0,44,1],[50,0,50,1],[51,0,51,1],[52,0,52,1],[53,0,53,1],[45,0,45,1],[46,0,46,1],[47,0,47,1],[48,0,48,1],[49,0,49,1]]}
["Invoice Submission Instructions"]
[null,"Each invoice must be password protected with your provider number, then emailed to the branch from which services were referred."]
["How to password protect your invoice:"]
[null,"Microsoft 2003: File>Save As>Tools>Options>Password to open: Enter DHS Provider #>OK>Reenter password at prompt>OK>Save>Close"]
[null,"Microsoft 2007:  Microsoft Office Button>Prepare>Encrypt Document>Enter DHS Provider #>OK>Reenter password at prompt>OK>Save>Close"]
[null,"Microsoft 2010: File>Info>Protect Workbook>Encrypt with Password>Enter DHS Provider #>Save>Close"]
["Email submission: "]
[null,"Invoices must be submitted via email to the branch from which services were referred. All Child Welfare branch offices have a standard email box that follows the naming convention: Branch.ContractInvoices@state.or.us. "]
["A complete list of branches across the state can be found by clicking here."]
[null,"Title your email subject line with your business name, the words contract invoice and the month/year being invoiced (\"Provider, Contract Invoice, 12/14\")"]
["Invoice Completion Instructions"]
["Field title",null,"Details"]
["Contract Invoice",null,"Complete the \"Contract Invoice\" template for purchases and for services with variable rates (as opposed to set monthly rates)."]
["One Twelfth Payments",null,"Complete the \"One Twelfth Payments\" template for services that are paid at a set monthly rate.  \n\nPLEASE NOTE: Provider information located in the top half of the invoice needs to be input on the \"Contract Invoice\" tab; from there it prefills the \"One Twelfth Payments\" tab. \n\nA separate invoice sheet (tab) is required to delineate any contracted services for which a provider receives a regular \"1/12th\" monthly rate.  For these types of contracts there is no \"rate per unit\" to provide nor will an \"invoiced amount\" be calculated.\n\nIt is important to submit a separate one-twelfth invoice for each contract and for each branch within a given contract. It is also imperative that the number of units be entered for each service. The type of unit, whether it is days, hours, etc., must be in compliance with the language of the related contract.  "]
["Provider number",null,"Primary contractor's DHS-assigned provider number, even if a sub-contractor or foster parent is providing the service. If unsure of the correct provider number, please contact the DHS contract administrator identified in the contract."]
["Provider name",null,"Name of the primary contractor as indicated on page one of the provider’s contracts."]
["Provider address",null,"Provider’s billing address. This is the location checks and remittance advice should be sent."]
["Provider contact",null,"Provider or provider staff who can answer questions about the invoice if necessary."]
["Contact email ",null,"E-mail address where the provider contact can be reached."]
["Invoice number",null,"This field is required to record a unique number assigned by the provider for each invoice.  This number will aid in the provider’s internal tracking purposes and will be printed on the remittance advice.  Limit this entry to no more than 11 alpha-numeric digits."]
["DHS branch ",null,"The name of the DHS branch to which the Invoice is sent by the Provider.  Examples: North Clackamas, Marion, Alberta, Medford.  If unsure of the correct branch name, please contact the DHS contract administrator identified in the contract.   "]
[null,null,"You can also find Child Welfare branch information by clicking here."]
["Billing month/year",null,"Month and year in which the services documented on the invoice were provided.  Do not bill for services provided in more than one month on the same invoice. Submit separate invoices for each month."]
["Contact phone",null,"Daytime phone number where the provider contact can be reached Monday - Friday."]
["Provider signature",null,"Provider authorization to request payment. Provider may type the authorizer's name into the Excel document."]
["DHS signature",null,"DHS USE ONLY: Typed name of DHS authorized representative. Note: this person must have an updated Delegation Signature Authorization (form 286) on file with approval for the amount of the invoice."]
["Date received by DHS branch",null,"DHS USE ONLY: This field provides space for DHS branch personnel to enter the date the emailed invoice was received in their office. You must use the \"/\" between fields. If the invoice is submitted in hard-copy format, this field needs to be date stamped."]
["Contract number",null,"Enter the contract number as it appears at the top of page one of the contract.\n\nFor placement services when a contract is being written and a contract number is not assigned yet, enter \"N/A\"."]
["Caseworker name",null,"Enter the name of the current DHS caseworker assigned to the referred client."]
["Case number",null,"Enter the DHS case number.  The Case number is indicated in the referral document or authorization from DHS that initiated the service. The DHS caseworker can also provide this information."]
["Foster provider / Subcontractor",null,"If neither scenario below applies, enter \"N/A\".\n\nFor placement services, enter the DHS issued foster/proctor provider number where the client was placed for the dates specified.  Each placement must be listed separately.\n\nFor services provided by a subcontractor, enter the DHS issued provider number for the subcontractor that provided services."]
["Participant name",null,"Enter the name of the individual who received the service.  If more than one individual under the same case number received the same service, the information for each participant must be entered on separate lines of the invoice.  "]
["Participant number",null,"Enter the DHS-assigned participant number for the individual who received the service.  Each individual referred for service has a unique participant ID number. The number can be found in the original referral document or service authorization from DHS. The assigned DHS caseworker can also provide this information."]
["Service category",null,"The service category and service type can be found on the referral document or authorization from DHS that initiated the service. The DHS caseworker can also provide this information. Contracts often provide for more than one service category or type. If an individual received more than one category or type of service within a given month, the different services must be accounted for on separate lines on the invoice.  "]
["Service type",null,"The service category and service type can be found on the referral document or authorization from DHS that initiated the service. The DHS caseworker can also provide this information. Contracts often provide for more than one service category or type. If an individual received more than one category or type of service within a given month, the different services must be accounted for on separate lines on the invoice.  "]
["Service start date",null,"Enter the 8 digit date with 2 digits for month, 2 digits for day and 4 digits for year. You must use the \"/\" between fields.\n\nFor services, enter the date on which the service began during the month that the invoice pertains to.  \n\nIf invoicing for expenditures of one or more “purchases”, as opposed to “services” indicate the date of the purchase.  If there were more than one purchase, enter the date of the first purchase. ONLY enter one total on one line of the invoice for all purchases in a given month separated by participant if there is more than one purchase per participant for the month.  Receipts must accompany the invoice with a note on each receipt that corresponds with the line number on which the purchase is listed on the invoice."]
["Service end date",null,"Enter the 8 digit date with 2 digits for month, 2 digits for day and 4 digits for year. You must use the \"/\" between fields.\n\nEnter the last date on which service was provided during this invoicing period.  \n\nIf invoicing for expenditures of one or more “purchases”, as opposed to “services”, for the participant, enter the purchase date."]
["Rate per unit",null,"Rate per unit as indicated in the contract's payment provisions or, if provided, the invoicing instructions issued after execution of the contract. If invoicing for reimbursement for “purchases”, as opposed to “services”, for the participant, enter the total dollar amount of all purchases in the month for the identified participant in this field. Attach a separate list of the individual purchases separated by participant if there is more than one purchase per participant for the month.  Please also include copies of receipts.  "]
["Number of units",null,"Enter the number of units of service provided during this invoicing period, i.e. the number of hours or quarter hours or days of service or other unit of service as described in the contract's payment provisions.  If invoicing for expenditures of “purchases”, as opposed to “services”, for the participant, enter “1” in this field. "]
["Invoiced amount",null,"This field is locked, so the user cannot enter data directly into it.  The field automatically displays the mathematical result of the amount entered in the “rate per unit” field multiplied by the number entered into the “number of units” field.   "]
["Service Outcome",null,"This field defaults to \"N/A\". Outcome selection to be made at service closure, only as required by contract. If your contract has not yet established outcome determinations, leave this field as \"N/A\"."]
["Notes",null,"DHS USE ONLY: Document information necessary for correct and accurate processing, including the service authorization, validation code and validation date."]
["Service authorization number",null,"DHS USE ONLY: Enter the service authorization number.  Each time DHS authorizes a contracted service for a given individual, the Department’s information system generates a unique service authorization number to aid DHS in service tracking and payment."]
["Validation code",null,"DHS USE ONLY: Enter an applicable Validation Code from this list:\nVP - Pay\nOP - Pay, One Time Payment\nNP - Do not pay\nAH - Agency Hold - withhold payment at this time while branch staff work internally to resolve.\nBH - BRS (Placement) Hold - withold payment at this time while branch staff work internally to resolve.\nCH - Contract Hold - withhold payment at this time while DHS staff work to finalize contract.\nPH - Provider Hold - withhold payment at this time while branch staff work with the provider to resolve."]
["Validation date",null,"DHS USE ONLY: Enter the date the service was validated. You must use the \"/\" between fields."]
["Button",null,"Instructions for Invoice Button Options"]
["Add a row",null,"With your cursor in any field of the invoice, click \"Add a row\" to insert a new row for entry at the bottom of the invoice. The invoice is set up to automatically add one row for provider entry with a joined row for DHS notes. These new rows are automatically numbered."]
["Copy a row",null,"Before you copy a row, you need to follow the instructions above to Add a row. Once you've added a row, place your cursor in any cell of the row you want to copy, click \"Copy row\". A message will pop up telling you \"Click on any cell in destination row to paste.\" Once you click into a cell where you want to paste, click \"Ok\" and your row will be copied and pasted. \n\nIf you accidentally select a cell in a row where you don't want to paste you can delete the cell name from the pop up box, hit Esc or select cancel. If you hit Esc or select cancel you will get a message stating \"Action Canceled.\""]
["Delete a row",null,"Select a cell where provider information has been input then click \"Delete a row\". This will delete your row of entry and its corresponding DHS notes row.\n\nPlease be very careful in selecting the row to delete because there is no way to undo this selection."]
["Reset row",null,"Once all data entry is complete on the monthly invoice and any necessary or desired sort has been applied, select \"Reset row\" to have all row numbers reset in sequence."]
["Freeze & scroll",null,"Select \"Freeze & scroll\" when entering several lines of data to allow the column headings to remain in sight."]
["Unfreeze rows",null,"Select \"Unfreeze rows\" to allow scrolling up and down through the entire invoice."]
["Caseworker sort",null,"Select \"Caseworker sort\" to see all services grouped together by caseworker."]
["Case number sort",null,"Select \"Case number sort\" to see all services grouped together by case number."]
["Contract number sort",null,"Select \"Contract number sort\" to see all services grouped together by contract number."]
["Sync invoice",null,"When provider and DHS staff work to validate invoice information it is recommended that both parties select the \"Sync Invoice\" button to re-align all invoice rows."]