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 |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |