Instructions For Completing Service Reporting Form Contractor Name Enter

instructions for completing service reporting form contractor name enter the agency’s name. contract provider number enter the

Instructions for Completing Service Reporting Form
Contractor Name
Enter the agency’s name.
Contract Provider Number
Enter the assigned contract provider number. Call Jessica
Shafer-Martinez at 573-2503 for your assigned provider number.
Therapist Number
Enter the name and the number of the therapist who provided the
service. For those employees/agencies for whom a therapist number has
not been assigned, call Justin Wong at 372-3289 to assign a therapist
number. NOTE: Any staff providing services under the contract must
have an NPI number. Justin Wong can provide information on how to
obtain one.
Month and Year
Enter the month and year the service occurred.
Client Name
Enter the client’s current legal name.
MH Number
Enter the client’s mental health number.
Service Type
Enter the number of minutes including documentation time under the
service type that describes the service rendered.
Location (Loc)
==============
Enter the code where the service was rendered. Please note that
billing rules look at location codes. Refer to Documentation Manual
for guidance on correct usage of location codes.
Svc Date
Enter the date the service occurred.
Svc Mins
Enter the total minutes
Total Minutes and Total Service Duration
========================================
Leave Blank - the spreadsheet will automatically calculate this
information
Filename:mhshared\M.I.S\InstructionsforCompletingContractorReportingforms\ServiceReporting.doc