| RHCD SERVICE PROVIDER INVOICE STATUS REPORT | ||||||||||
| FOR RHCD USE ONLY | ||||||||||
| Service Provider Name | RHCD Processed Date | |||||||||
| SPIN | Number of Records | |||||||||
| Service Provider Invoice Number | Number of Records Approved | |||||||||
| Invoice Date to RHCD (mm/dd/yy) | RHCD Approved Total Amount | |||||||||
| Total Invoice Amount | ||||||||||
| Funding Year (yyyy) |
HCP # | Funding Request # |
HCP Entered Billing Account # | Multiple Months (Y or N) | Support Date (mmyyyy) | Support Amount to be Paid by USAC | Code | |||
| 1 | A - Approved | |||||||||
| 2 | A - Approved | |||||||||
| 3 | A - Approved | |||||||||
| 4 | A - Approved | |||||||||
| File Type | application/vnd.ms-excel |
| Author | rayalur |
| Last Modified By | Nicole Ongele |
| File Modified | 2016-07-22 |
| File Created | 2009-02-12 |