Exp by xiuliliaofz

VIEWS: 12 PAGES: 3

									              Milwaukee County Department of Health and Human Services (DHHS)
                                                        Billing Instructions


1 Data can be entered in "grayed" cells ONLY.
  - Choose Ending month from drop down box on the "Exp" tab.
  - Choose Division from drop down box on the "Exp" tab.
  - Choose start and end month of the contract from the drop down menu on "Exp." Tab.
  - Choose Type of Reimbursement Partial or Final from the Drop down Menu on "Exp." Tab.

2 Any prior period adjustments should be made in the current month.
  - DO NOT MAKE CHANGES TO MONTHS YOU HAVE ALREADY BILLED.
  - Footnote any prior period adjustments on the current month report on the "Exp" Tab in Comment Box

3 INCREASES IN REVENUES AND EXPENSES SHOULD BE ENTERED AS POSITIVE NUMBERS.

4 DECREASES IN REVENUES AND EXPENSES SHOULD BE ENTERED AS NEGATIVE NUMBERS.

5 Please do not enter "Text" in numerical fields or vise versa.

6 Please email the report to dhhsaccounting@milwcnty.com the subject line should read : Division, Agency, Program and Month
  example: DSD ABC LLC TCM January 10




                                                                                                           Instructions 5/13/04
                                                                                        Milwaukee County Department of Health and Human Services (DHHS)

                                                                                                              2010 PROFESSIONAL SERVICES EXPENSE STATEMENT
Agency            Name                                                                                                                                                                                               Month EndingJANUARY

Address           Address
Program                                                                                                                                                                                                           Certified By
Contract #                                                                                                                                                                                                          Agency Representative
Division           BHD                                                    Reimbursement                                     Important: DO NOT MAKE CHANGES TO MONTHS YOU HAVE ALREADY BILLED.                        Email       email address
                                                                                                                           Please adjust current month numbers and explain in the comment box at the end of
Contact                                                                   Partial                                                                                                                                    Fax #       123 456-7980
                                                                                                                                                          the month column.
                  Starting Month        Ending Month                                                                                                                                                                Phone #      123 456-7890
Contract           JANUARY              DECEMBER
EXPENSES

                                        January February       March        April      May         June          July          August   September October Novembe       December    Final     YTD       YTD         Balance        Balance        Approved       Approved          Approved
        Services Description             Units   Units         Units        Units      Units       Units         Units         Units      Units    Units  r Units        Units      Units     Units   Expenses       Units         Amount       Original
                                                                                                                                                                                                                                                    Units        Unit rate
                                                                                                                                                                                                                                                                 Original           Budget
                                                                                                                                                                                                                                                                               $
!                                           -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
!                                           -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
    !                                       -            -            -            -          -           -            -           -          -         -         -          -          -         -           -           -               -               -              -               -
            Total Units                     -            -            -            -          -           -            -           -          -         -         -          -          -         -

                             January:              February: March:       April:       May:       June:        July:          August:   September   October:   Novemb   December   Final
Total Net Expenses/Request                  -            -            -            -          -           -            -           -    :     -         -      er:
                                                                                                                                                                   -    :    -           -
                                                                                                                                                                                   Expense:       -           -           -               -               -                              0.00




Email to:dhhsaccounting@milwcnty.com                (the subject line should read : Division, Agency, Program and Month example: DSD ABC LLC TCM January 08)
Fax: DHHS Accounting @ (414) 289-8574




                                                                                                                                                                                                                                    File: 7539d987-38b7-4e78-8444-fce280fc73fe.xls
                                                                                                                                                                                                                                                                   Worksheet: Exp
                                                                                                                                                                                                                                                                Printed: 11/4/2011
                                                                                                                                                                                                                                                           Form 162 (Rev 1/04/10)
                           Milwaukee County Department of Health and Human Services (DHHS)

                             2010 PROFESSIONAL SERVICES EXPENSE STATEMENT

Agency        Name                                                         Month Ending             JANUARY
Address       Address
Program                                                                    Certified By
Contract #                                                                            Agency Representative
Division           BHD                                                      Email        email address
Contact                                                                                           Fax # 123 456-7980
                   Start            End           Reimbursement                                 Phone # 123 456-7890
Contract         JANUARY        DECEMBER              Partial
EXPENSES
                                  January       YTD               YTD        Balance          Balance       Approved
    Services Description           Units        Units           Expenses      Units           Amount         Budget
                                                            $                             $
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -                            -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
!                                         -             -              -           -                    -              -
           Total Units                    -             -              -           -                    -              -


Total Net Expenses/Request                -


Email to:dhhsaccounting@milwcnty.com
Fax: DHHS Accounting @ (414) 289-8574

								
To top