October 2014 Broward County Government Human Services Department Community Partnerships Division FY2015 Provider Information
TOPICS Provider Resources Invoicing Quarterly Reports Other Required Reports
PROVIDER RESOURCES
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ACCESSBROWARD REGISTRATION CONT. Step 4: Once you have signed in check mark Community Partnerships Contracted Provider and click Save Changes to apply your subscription. Once you have saved your subscription any notifications for the Community Partnerships Contracted Provider group will be sent to your email. *To ensure future emails from AccessBROWARD are not treated as spam and you receive all email notifications, please add no-reply@broward.org to your email account contact list.
CONTRACTED PROVIDER HANDBOOK WEBPAGE Contracted Provider website (http://www.broward.org/humanservices/communitypartnerships/ Pages/ContractServicesProviderHandbook.aspx)
INVOICING
REGULAR INVOICE SUBMISSION PACKET 1 (submitted monthly) Original invoice System generated summary report PACKET 2 (submitted monthly) Copy of invoice Copy of system generated summary report System generated detail activity report Certificate of payment to subcontractors and suppliers PACKET 3 (submitted quarterly) A complete Quarterly Report includes; Packet 1 Packet 2 Outcome Report Demographic Report Narrative Report
INVOICES CONTAINING CORRECTED BILLING INFORMATION ADDITIONAL OR DISALLOWED PACKET 1 (submitted monthly) Original invoice System generated summary report for current invoice Before and After system generated summary reports from month in which services were rendered Completed Required Services Documentation form for all added or disallowed billing PACKET 2 (submitted monthly) Copy of invoice Copy of system generated summary report for current invoice System generated detail activity report for current invoice Copy of Before and After system generated summary report from month in which services were rendered Copy of completed Required Services Documentation form for all added or disallowed billing Certificate of payment to subcontractors and suppliers
INVOICE REVIEW When the invoice is received, the Community Partnerships staff reviews the invoice for correctness. Incorrect invoices will be voided and returned and may delay payment. The revised invoice must include a new signature and date upon resubmission. Late submission (past date due) of invoices and or other documents will be noted on monitoring reports and may result in a remedial or corrective action.
INVOICING AND BACK BILLING SCHEDULE Quarter 1 Quarter 2 Quarter 3 Quarter 4 Month of Service Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Invoice Due* Nov 15 Dec 15 Jan 15 Feb 15 Mar 15 Apr 15 May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Corrections Due* Feb 15 Mar 15 Apr 15 May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Nov 15 Nov 15 ***IMPORTANT*** Providers are only allowed to back bill once for any given month. Quarterly Reports due at the end of each quarter. *If due date falls on a weekend or a County observed holiday, invoices/correction packets are due the next business day.
INVOICE, PAGE 1 Billing Period: October-12 FY 2014 (page 1 for Contracts with Match) Board of County Commissioners, Human Services Department Contracted Services Invoice Agency Name: Customer # Contract #: Address 1 DATE STAMP AREA Program Name: Address 2 Program #: Contract/Prog. Amount: City, St, Zip A. Grand Total $ For Units Delivered This Month (from page 2, "A") B. Match this month C. Net Amount Requested for Reimbursement/Month D. Net Amount Requested Year-to-Date E. Match Contribution YTD On Time Late F. CERTIFICATION: The undersigned, as an authorized signator for the contract between Broward County and hereby affirms and certifies that the services billed herewith have been delivered to clients on behalf of Broward County per agreement, that all clients served have met the program eligiblity requirements, and that sufficient written information is available to document services. Provider also represents to County that no other reimbursement is used for invoiced services. G. Approved Signator Name (typed): Title: H. Authorized Signature: Date: THIS SECTION FOR COUNTY USE ONLY Division Reviewer/Date: CERTIFICATION OF PAYMENTS TO SUBCONTRACTORS AND SUPPLIERS pexhibit C Required pnot Required; subcontracting not authorized by COUNTY Fund/Agency/Organization/Object: I hereby certify that the backup documentation is complete, accurate, supports the payment and pricing requested and is on file in the Division. Administrative Services Reviewer/Date: Outcomes met for quarter? Yes, invoice not adjusted No, invoice adjusted Submission of previously unbilled units: Y or N. If "Y", submit additional backup documentation to substantiate the unbilled units of service. Are any disallowed units from previous monitoring visits or Medicaid or Medicare payments included in this invoice? (Y or N. If "Y" then see p.2 ) Comments:
INVOICE, PAGE 2 Agency Name: Billing Period: October-12 Contract #: Program Name: Program #: A. FY 2014 (page 2) Board of County Commissioners, Human Services Department Contracted Services Invoice Grand Total Units Billed (add additional sheets if more than 17 types of units) Taxonomy Unit/Service Type (Unit Cost) x (# Units this month - # Disallowed Units) = Total $ Value 1 x - = 90% of Total $ Value of Units Total Billable Value YTD Annual Maximum 2 x - = 3 x - = 4 x - = 5 x - = 6 x - = 7 x - = 8 x - = 9 x - = 10 x - = 11 x - = 12 x - = 13 x - = 14 x - = 15 x - 16 x - 17 x - = = = Total Billable Value for This Month (to page 1, "A") 1 Total Match This Month 2 Previous Month YTD 3 Required Contribution (10% of the amount billed year-to-date):
REQUIRED SERVICES DOCUMENTATION Agency Name: Billing Period: Contract #: Taxonomy/Unit: Program Name: Program #: Client ID: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 date of entry: date of exit: Total units: 3rd Party Payments Type: Client ID: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 date of entry: date of exit: Total units: 3rd Party Payments Type: Client ID: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 date of entry: date of exit: Total units: 3rd Party Payments Type: Client ID: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 date of entry: date of exit: Total units: 3rd Party Payments Type: Client ID: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 date of entry: date of exit: Total units: 3rd Party Payments Type: Client ID: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 date of entry: date of exit: Total units: 3rd Party Payments Type: Client ID: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 date of entry: REQUIRED SERVICES DOCUMENTATION date of exit: Total units: 3rd Party Payments Type: Total # units this page: Total 3rd party $$ this page: FIRST PAGE ONLY: Grand total # units: Grand total 3rd party $$: Verified by:
QUARTERLY REPORTS
QUARTERLY REPORTS Demographic Report remember to circle appropriate quarter. Outcome Report needs to have all required signatures and dates. Narrative Report - needs to list any barriers in outcome achievement & noteworthy activities. Evidence based programs must include methodology used to complete outcome report.
DEMOGRAPHICS FORM Provider's Name: CIRCLE THE QUARTER#: 1 2 3 4 Program name/number: Contract#: Date completed: CIRCLE ONE Original or Revision Qtr Qtr Qtr Qtr 1 2 3 4 Total a. Number of Clients at the beginning of quarter. 0 b. Number of NEW Clients entering services during quarter. 0 c. Number of Clients (discharged in FY14) re-entering services during quarter. 0 d. Total of Line A, B and C. 0 0 0 0 0 e. Number of Clients discharged during quarter. 0 f. Total number of Clients at the end of quarter. 0 0 0 0 0 g. Total number of UNDUPLICATED Clients served, year-to-date. 0 0 0 0 0 D a t e S t a m p Data below must reflect the total of ALL (unduplicated) clients served year to date for this Agreement (See f. above). Total Est Pov. Level AGE 0-5 6-10 11-14 15-17 18-21 22-29 30-39 40-49 50-59 60+ Total all Under Over ages < > GENDER M F M F M F M F M F M F M F M F M F M F M F RACE / ETHNICITY 1. Asian 0 0 0 2. Black 0 0 0 3. White 0 0 0 4. Haitian 0 0 0 5. Hispanic 7. Native American 0 0 0 8. Other 0 0 0 9. Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 An unduplicated client is defined as an individual who is counted one time during the contract year, even though that individual may receive multiple services or have more than one episode of care.
Provider's Name: Agreement #: Program Name/Number: 1 Submission Status (Circle appropriate status): Original Revision Circle Quarter #: 1 2 3 4 OUTCOMES FORM Date Rec'd: Preparer Name/Title (Print): Preparer Signature: Approver Name/Title (Print): Approver Signature: Item 2 3 Outcome Measure # Indicator # Relevant Clients: Clients who have received the service referenced in the indicator. Item Qtr 1 Qtr 2 Qtr 3 Qtr 4 YTD Total # of Clients receiving services referenced in indicator 4 during each quarter 0 # Clients pending first evaluation (have not been in services 5 long enough) 0 # Clients who dropped out of program and were unable to be 6 evaluated (Only Children's Services Providers) 0 # Clients unable to be evaluated (data missing, and other - 7 explain in narrative) 0 8 # Clients previously evaluated for the indicator 0 # of Clients meeting time frame to be evaluated for the 9 indicator 0 0 0 0 10 # of Clients attaining the Indicator 0 11 % Attainment reported for the Quarter #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Item 2 3 Outcome Measure # Indicator # Relevant Clients: Clients who have received the service referenced in the indicator. Item Qtr 1 Qtr 2 Qtr 3 Qtr 4 YTD Total # of Clients receiving services referenced in indicator 4 during each quarter 0 5 # Clients pending first evaluation (have not been in services long enough). 0 6 # Clients who dropped out of program and were unable to be evaluated (Only Children's Services Providers) 0 7 # Clients unable to be evaluated (data missing and other - explain in narrative) 0 8 # Clients previously evaluated for the indicator. 0 9 # of Clients meeting time frame to be evaluatedfor the indicator 0 0 0 0 0 10 # of Clients attaining the Indicator 0 11 % Attainment reported for the Quarter #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
IMPORTANT! CPD will deduct 3% of the third invoice of any quarter in which a performance indicator is not met within 5% of the outcome goal for that quarter.
OTHER REQUIRED REPORTS
THE FOLLOWING REPORTS MUST BE SUBMITTED TO CONTRACT GRANTS ADMINISTRATOR WITHIN 30 CALENDAR DAYS OF RECEIPT BY PROVIDER: Monitoring reports issued by agencies or funding source for similar services. Accreditation reports Single audit reports
CLIENT SATISFACTION SURVEY Blank Copy of Provider s Client Satisfaction Survey Due when Agreement is executed, and when updated Compiled Client Satisfaction Survey Due annually by July 15 th
IMPORTANT! All required reports must be received on or before the due date to avoid suspension of payment.
THE WELL ANTICIPATED PAPER COLOR OF FY2015 IS... Lunar Blue
ADDITIONAL QUESTIONS? CALL US AT: (954) 357-7880 CSA (954) 357-6101 HIP (954) 357-5385 HCS
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