Provider Invoices & Reporting Requirements

Invoice Form(s)

• American Behavioral Health Systems Invoice Forms

Required Reports and Timeframes

Monthly

• SUD Withdrawal Management Census Report
• SUD Residential Census Report

Quarterly

• Clinician Roster
• Contractor Profile Update

Semi-Annual

• None

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Disaster Recovery and Business Continuity Plan Update(s)
  

Invoice Form(s)

• Build 2 Lead Invoice Forms

Required Reports and Timeframes

Monthly

• Community Driven BH Services MIDD data

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Invoice Form(s)

• Community Leaders Roundtable of Seattle – dba. Choose 180 Invoice Forms

Required Reports and Timeframes

Monthly

• Community Driven BH Services MIDD data

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Invoice Form(s)

• Fresh Start Professional Services Invoice Forms

Required Reports and Timeframes

Monthly

• Community Driven BH Services MIDD data

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Invoice Form(s)

• FW Black Collective Invoice Forms

Required Reports and Timeframes

Monthly

• Community Driven BH Services MIDD data

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Invoice Form(s)

• Indian American Community Services Invoice Forms

Required Reports and Timeframes

Monthly

• Community Driven BH Services MIDD data

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Invoice Form(s)

• Asian Counseling and Referral Service Invoice Forms

Required Reports and Timeframes

Monthly

• Community Driven BH Services MIDD data
• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Forensic Treatment CCAP Staffing Report
• Older Adult SUD FTE Report
• Older Adult SUD Performance Report
• WASEC Healthcare Worker Services Program Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Supported Employment Program (SEP) Quarterly Report
• SEP Quarterly Report – Supplemental (as needed)
• Third Party Payment Report

Semi-Annual

• Older Adult SUD Narrative Report regarding program challenges and successes

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity (DRBC) Plan
• WASEC Healthcare Worker Services Program Annual Report
• MIDD Annual Narrative Report

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Community Driven BH Services MIDD data

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement*
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)
• MIDD Annual Report Narrative

Invoice Form(s)

• Auburn School District Invoice Forms

Required Reports and Timeframes

Monthly

• 2021-2022 Auburn SBIRT Financial Report
• ASD Auburn Prevention Coalition Monthly Actual Expenditure Report Form and Summary 2021-2023 
• Minerva Monthly Report

Quarterly

• Minerva Quarterly Report

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

Invoice Form(s)

• Catholic Community Services of Western Washington Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• DRS Interim Housing Report
• Outreach and Engagement at Matt Talbot Center –Staffing Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• N/A

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement
• Closure Dates Report
• Client Success Stories (upon request)
• Disaster Recovery Business Continuity Plan Update(s)
• Individual Vignette for DRS Interim Housing

Invoice Form(s)

• Center for Human Services Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Mental Health Outpatient: Infant-Child Expanded Assessment Form
  
• PPW On-Site Child Care Services Report
• Wraparound – Contract Summary Report
• Wraparound – Flex Fund Expenditures Report
• Wraparound Flex Fund Request
• Wraparound Flex Fund Request – Interpreter Form
• Wraparound Flex Fund Request – Special Event
• Youth Diversion Tracking Report
• Youth Diversion Services Status Report to CDS
• Youth Support Services (YSS) Narrative Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report
• YSS Quarterly Report

Semi-Annual

• N/A

Invoice Form(s)

• Childhaven Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Mental Health Outpatient: Infant-Child Expanded Assessment Reimbursement Form
  

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third-Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity (DRBC) Plan Update(s)

Invoice Form(s)

• Coalition Ending Gender-Based Violence Invoice Forms

Required Reports and Timeframes

Monthly

• Domestic Violence Behavioral Health (DV-BH) Services Monthly Staffing Report
• DV-SA BH System Coordination Monthly Activity Report
• DV-SA BH System Coordination Monthly Training Report

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Invoice Form(s)

• Community House Mental Health Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• LINC Client Level Record
• LINC Report Log
• LINC Quarterly Aggregate Data (monthly report)
• Long-Term Residential (LTR) Services Reimbursement Request & Billing Report Services Summary
• Supervised Living (SL) Services Reimbursement Request Billing Report Services Summary
• SMC Competency Boundary Spanner Report
• SSH-ISH Monthly Report
• Trueblood Phase III Client Record Datasheet

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• None

Invoice Form(s)

• Consejo Counseling & Referral Service Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Invoice Form(s)

• County Doctor Community Health Center Invoice Forms

Required Reports and Timeframes

Monthly

• MAT-EPIC Staff Report

Quarterly

Semi-Annual

Annual/Other

Invoice Form(s)

• Cowlitz Indian Tribe Invoice Forms

Required Reports and Timeframes

Monthly

• None

Quarterly

• Contractor Profile Update
• Tribal Substance Use Disorder Treatment Services Report
• Tribal Mental Health Services Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

Invoice Form(s)

• Crisis Connections Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Emergency Telephone Services
  • Daily Crisis Log (sent to Clinical Team)
  • Daily Crisis Log – CC Business Line (sent to Clinical Team)
  • Daily Crisis Log – CC Crisis Line (sent to Clinical Team)
  • Crisis Line Wait Time Intervals Monthly Reports (sent to Quality Team)
  • Monthly Crisis Line Caller Data Report
  • Next Day Appointment Report
  • Mobile Crisis Team Dispatch Report
  • CCPAR Line Volume and Outcomes Report
  • CCPAR Business Line Report
  • FTE Call Screener Report
  • Voluntary Hospital Authorization Report
  • UM Report
• Low-Barrier Buprenorphine
  • Recovery Helpline Low-Barrier Buprenorphine FTE Report
  • RHL MOUD Report
• Patient Placement Coordination
  • PPC Placement Outcomes Summary Report
  • PPC Call Volumes Summary Report
• Telephone Service for Crisis and Commitment Services
  • TSCCS Telephone Summary Report – CCS Professional Line
  • TSCCS Triage Summary Report – CCS Public Phone Line
  • Sheena’s Law Report
• Warm Line
  • Warm Line Volunteer Report
  • Warm Line Call Report
  • Warm Line Profit & Loss Report
• Warm Line Trial Balance Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Emergency Telephone Services
  • Access Report
  • Crisis Line Caller Data Report
  • CCPAR Crisis Line Report
  • CCPAR Business Line Report
• Lifeline Access Report
• Lifeline King County Report
• Third Party Payment Report
• Warm Line
  • Warm Line Quarterly Access Report
  • RH Call Status Report
  • Caller Data Report: Warm Line Quarterly Report
• Quarterly Reconciliation Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement*
• Certificate of Insurance & Endorsement*
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)
• Warm Line
  • Warm Line Yearly Access Report

Invoice Form(s)

• Daybreak Youth Services Invoice Forms

Required Reports and Timeframes

Monthly

• SUD Residential Census Report-Youth Intensive Inpatient
• SUD Residential Census Report-Youth Co-Occurring Disorders

Quarterly

• Clinician Roster
• Contractor Profile Update

Semi-Annual

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Disaster Recovery Business Continuity Plan Update(s) 

Invoice Form(s)

• Domestic Abuse Women’s Network Invoice Forms

Required Reports and Timeframes

Monthly

• Domestic Violence Behavioral Health (DV-BH) Services Monthly Summary Report
• DV-BH Services Monthly Staffing Report
• DV-BH Services MIDD data to Client Outcome Reporting Engine (CORE)

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Invoice Form(s)

• Downtown Emergency Service Center Invoice Forms

Required Reports and Timeframes

Monthly

• 1811 Intensive Case Management (ICM) FTE Report
• Assisted Outpatient Support Program Tracking Form
• BHRT Actual Monthly Expenditures Report
• BHRT Monthly Report
• CDF Monthly report
• Community Outreach and Advocacy Team (Coat) Crisis Housing Voucher Monthly Log
• Crisis Respite Program (CRP) Report
• CRP Census Log
• CRP Referrals Denied Report
• CSC Actual Monthly Expenditures Report, Per Program Component
• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Housing and Recovery Through Peer Services (HARPS) CBRA Monthly Log
• Homeless Outreach, Stabilization and Treatment (HOST) KCMHP Transfer Report
• Housing and Recovery Through Peer Services (HARPS) Participant Log
• MCT Monthly Report
• Morrison Housing Report
• PACT Monthly Report
• PATH HMIS Report
• PATH HMIS Performance Report
• Pathfinder Peer Project HMIS Report
• Services and Housing to Access Recovery Program (SHARP) Caseload Report
• WASPC Grant Monthly Reporting Requirements

Quarterly

• 1811 ICM Project Narrative Report
• CDF Quarterly Report
• CDIS Quarterly Report
• Clinician Roster
• Contractor Profile Update
• CSC Quarterly Expenditures Report, Per Program Component
• HARPS Quarterly Report
• HOST Quarterly Report
• Low-Barrier Buprenorphine Treatment Expansion Report
• MCT Quarterly Report
• PATHPerformance Report/PATH FTE Report
• Peer Pathfinder Implementation Report
• SEP Quarterly Outcomes Report
• SEP Quarterly Outcomes Supplemental Report (as needed)
• Third Party Payment Report

Semi-Annual

• PACT Transition Assessment Scale

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• CRP Annual Staffing Plan
• Disaster Recovery Business Continuity Plan Update(s)
• PATH Annual Report
• SEP MIDD Client Success Stories (as requested)

Required Reports and Timeframes

Monthly

• Census Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Attestation and Plan Update(s)

Invoice Form(s)

• Enumclaw School District Invoice Forms

Required Reports and Timeframes

Monthly

• Enumclaw Monthly Actual Expenditure Report and Summary 2021-2023 v1
• Monthly Minerva Report

Quarterly

• Quarterly Minerva Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

Required Reports and Timeframes

Monthly

• Census Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity (DRBC) Plan Update(s)

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Evergreen Treatment Services Invoice Forms

Required Reports and Timeframes

Monthly

• ARPA RNP Data Collection Tool V4
• ARPA RNP Expenditure Report
• ARPA RNP Monthly Staffing Report
• Data and encounter submission to the BHRD Management Information System
• Data Certification Letter
• Reentry Case Management Services Staffing Report
• SUD Mobile Medical Van FTE Report
• RNP State-HCA Expenditure Report
• State-HCA RNP Data Collection Tool V4
  

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report
• SUD Mobile Medical Van Evaluation Report

Semi-Annual

Annual/Other

• Audited Financial Statement
• Certificate of Insurance and Endorsement
• Closure Dates Report
• Client Success stories upon request
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Excelsior Youth Center Invoice Forms

Required Reports and Timeframes

Monthly

• SUD Residential Census Report

Quarterly

• Clinician Roster
• Contractor Profile Update

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Closure Dates Report
• Client Success Stories (upon request)
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Friends of Youth Invoice Forms

Required Reports and Timeframes

Monthly

• Community Drive BH Services MIDD data
• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Youth Support Services (YSS) Narrative Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report
• YSS Quarterly Report

Semi-Annual

• N/A

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)
• MIDD Annual Narrative Report

Invoice Form(s)

• Guided Pathways Support for Youth and Families Invoice Forms

Required Reports and Timeframes

Monthly

• GPS Family Support Organization Monthly Progress Report
• GPS FSO MIDD Evaluation Data Report/ CORE Reporting

Quarterly

• None

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance and Endorsement
• Client Success Stories (Upon Request)
• GPS Workplan and Year End Summary (Upon Request)

Invoice Form(s)

• Harborview Allied and Ambulatory Services (Harborview Abuse and Trauma Center) Invoice Forms

Required Reports and Timeframes

Monthly

• Sexual Assault Behavioral Health (SA-BH) Services Monthly Summary Report
• SA-BH Services data to Client Outcome Reporting Engine (CORE)

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Invoice Form(s)

• Harborview Behavioral Health Services (HBHS) Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Mental Health and Substance Use Outpatient Services
  • Data and encounter submission to the BHRD Management Information System
• Emergency Department/Psych Emergency Services Care Manager
  • ED PES Care Manager FTE Report
  • ED PES Care Manager Voucher Detail Report
• Peer Bridger Program
  • Peer Bridger Program Voucher Report (sent directly to Amanda)
  • Peer Bridger Program FTE Report (sent directly to Amanda)
• Screening, Brief Intervention, and Referral to Treatment (SBIRT) Emergency Department Services
  • SBIRT-EDS Narrative Report (sent directly to Jennifer Wyatt)
• Involuntary Treatment Triage
  • Involuntary Treatment Triage Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report
• Emergency Department/Psych Emergency Services Care Manager
  • ED PES Care Manager Log
• Supported Employment Program (SEP)
  • SEP Quarterly Report (sent directly to Lisa Floyd)
  • SEP Supplemental Quarterly Report (sent directly to Lisa Floyd) as needed

Semi-Annual

• None

Annual/Other

• SBIRT Emergency Department Services
  • Provide specific information for the MIDD Annual Report as requested by the County
• Supported Employment Program
  • Provide specific information for the MIDD Annual Report as requested by the County as needed
• Involuntary Treatment Triage
  • Involuntary Treatment Triage Annual Report
• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Hepatitis Education Project Invoice Forms

Required Reports and Timeframes

Monthly

• Medication-Assisted Treatment (MAT)- Shelters/Encampments Services Monthly Supplies and Equipment Billing Report
• MAT-Shelters/Encampments Services Monthly Staffing Report
• MAT Shelters/Encampments Services MIDD data to Client Outcome Reporting Engine (CORE)

Quarterly

• None

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Invoice Form(s)

• Hero House NW Invoice Forms

Required Reports and Timeframes

Monthly

• Clubhouse Census Log
• Consumer-Driven Services Clubhouse Census Log
• Data Certification Letter
• Data and encounter submission to the BRD Management Information System
• Consumer-Driven Services: Progress note to the Outpatient Benefit holder for each enrolled consumer served that contains a summary of activities and attendance

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report
• SEP Quarterly Report
• SEP Supplemental Quarterly Report (as needed)

Semi-Annual

• Clubhouse Services Summary Report
• Consumer-Driven Services Clubhouse Services Summary Report

Annual/Other

• Closure Dates Report
• Consumer-Driven Services Report (upon request)
• Audited Financial Statements
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Disaster Recovery Business Continuity Plan Updates(s)
• SEP MIDD (upon request)

Invoice Form(s)

• IKRON Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• HARPS Housing Bridge Subsidy (as needed)
• PACT Monthly Report
• PACT CBRA Monthly Log

Quarterly

• Clinician Roster
• Contractor Profile Update
• Supported Employment Program (SEP) Quarterly Report
• SEP Quarterly Report – Supplemental (as needed)
• Third Party Payment Report

Semi-Annual

• PACT Transition Assessment Scale

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Updates(s)

Invoice Form(s)

• Institute for Family Development Invoice Forms

Required Reports and Timeframes

Monthly

• FFT FTE Report
• FFT Services and Activities Report
• FFT Therapist Activities Report
• ZYD Services Report

Quarterly

• YSS Quarterly Narrative Report

Semi-Annual

• None

Annual/Other

• None

Invoice Form(s)

• Integrative Counseling Services Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• N/A

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Updates(s)

Invoice Form(s)

• Intercept Associates Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• N/A

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement
• Client Success stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Interchange Northwest Invoice Forms

Required Reports and Timeframes

Monthly

• Ombuds Service Monthly Report
• Ombuds Service Monthly Time Sheet

Quarterly

• Contractor Profile Update
• Grievances and Fair Hearings Quarterly Report
• Ombuds Service Quarterly Telephone Contact Log

Semi-Annual

• Ombuds Service Semi-Annual Report

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan

Invoice Form(s)

• Kent Youth and Family Services Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Mental Health Outpatient: Infant-Child Expanded Assessment Reimbursement Form
  
• Youth Support Services (YSS) Narrative Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• YSS Quarterly Report

Semi-Annual

• N/A

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• King County Sexual Assault Resource Center Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Sexual Assault Behavioral Health (SA-BH) Services Monthly Summary Report
• SA-BH Services MIDD data to Client Outcome Reporting Engine (CORE)

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)
• MIDD Annual Narrative Report

Invoice Form(s)

• LifeWire Invoice Forms

Required Reports and Timeframes

Monthly

• Domestic Violence Behavioral Health (DV-BH) Services Monthly Summary Report
• DV-BH Services Monthly Staffing Report
• DV-BH Services MIDD data to Client Outcome Reporting Engine (CORE)

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update

Invoice Form(s)

• Metropolitan Development Council Invoice Forms

Required Reports and Timeframes

Monthly

• Evaluation and Treatment (E&T) Census Report
• E&T Seclusion and Restraint Report
• E&T Monthly Admission Denial Log
• Withdrawal Management Census Report

Quarterly

• Clinician Roster
• Contractor Profile Update

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Muckleshoot Indian Tribe Invoice Forms

Required Reports and Timeframes

Monthly

• None

Quarterly

• Contractor Profile Update
• Tribal Substance Use Disorder Treatment Services Report
• Tribal Mental Health Services Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System

Quarterly

• Clinician Roster
• Third Party Payment Report
• Contractor Profile Update

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

• NAMI Eastside Invoice Forms

Invoice Form(s)

• NAMI Greater Seattle Invoice Forms

Required Reports and Timeframes

Monthly

• KC Consumer Training Fund Expenditure Report

Quarterly

• Contractor Profile Update

Semi-Annual

• KC Consumer Training Fund Status Report

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Closure Dates Report
• KC Consumer Training Fund Conference and Seminar Approval List Report

• NAMI South King County Invoice Form

Invoice Form(s)

• Navos Invoice Forms

Required Reports and Timeframes

Monthly

• Adult Crisis Services Monthly Crisis Housing Voucher Log
• Assisted Outpatient Services Program (AOSP) Monthly Crisis Housing Voucher Log
• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• ICSRP Census
• ICSRP Engagement Log
• Long-Term Residential (LTR) Residential Monthly Billing Report Services/Census
• Mental Health Outpatient: Infant-Child Expanded Assessment Reimbursement Form
• PACT Monthly Report
• Peer Bridger Staffing Report
• Peer Bridger Voucher Report
• Standard Supportive Housing (SSH) Report

Quarterly

• Clinician Roster
• Third Party Payment Report
• Contractor Profile Update

Semi-Annual

• PACT Transition Assessment Scale

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• NeighborCare Health Invoice Forms

Required Reports and Timeframes

Monthly

• Community Driven BH Services MIDD data

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Invoice Form(s)

• Neighborhood House Invoice Forms

Required Reports and Timeframes

Monthly

• PEACE Monthly Actual Expenditure Report and Summary 2021-2023
• Minerva Monthly Report

Quarterly

• Minerva Quarterly Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance and Endorsement
• Client Success Stories (Upon Request)

Invoice Form(s)

• New Beginnings Invoice Forms

Required Reports and Timeframes

Monthly

• Domestic Violence Behavioral Health (DV-BH) Services Monthly Summary Report
• DV-BH Services Monthly Staffing Report
• DV-BH Services MIDD data to Client Outcome Reporting Engine (CORE)

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Invoice Form(s)

• New Traditions Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• PPW & Child Care Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• N/A

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Olalla Recovery Centers Invoice Forms

Required Reports and Timeframes

Monthly

• SUD Residential Census Report-Adult Intensive Inpatient

Quarterly

• Clinician Roster
• Contractor Profile Update

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Oxford House Invoice Forms

Required Reports and Timeframes

Monthly

• Rapid Re-Housing FTE Report
• Rapid Re-Housing Monthly Report

Quarterly

• None

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• MIDD Annual Narrative Report

Invoice Form(s)

• Peer Washington Invoice Forms

Required Reports and Timeframes

Monthly

• Community Driven BH Services MIDD data
• Recovery Support Services Reimbursement Summary
• Recovery Navigator Program (RNP) State-HCA Expenditure Report

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Invoice Forms

• Pioneer Human Services Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification
• FIRS General Ledger
• Housing Services for King County Regional Mental Health Court Data-Status-Log Report
• Sobering Adult Case Management Services
• SUD Residential Census Report

Quarterly

• Clinician Roster
• Contractor Profile Update

Semi-Annual

• None

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Disaster Recovery and Business Continuity Plan Update(s)

Invoice Form(s)

• Public Defender Association Invoice Forms

Required Reports and Timeframes

Monthly

• LEAD Monthly Report

Quarterly

• None

Semi-Annual

• None

Annual/Other

• None

Invoice Form(s)

• Puget Sound Educational Service District Invoice Forms

Required Reports and Timeframes

Monthly

• CDFY Monthly Actual Expenditure Report and Summary 2021-2023
• PSESD_SB_SBIRT_CPWI_Pilot_Project_Monthly_Report 2021-2022
• Minerva Monthly Report

Quarterly

• Minerva Quarterly Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance and Endorsement
• Client Success Stories (Upon Request)

Invoice Form(s)

• Real Escape from the Sex Trade Invoice Forms

Required Reports and Timeframes

Monthly

• Community Driven BH Services MIDD data

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Invoice Form(s)

• Recovery Café Invoice Forms

Required Reports and Timeframes

Monthly

• MIDD data to Client Outcome Reporting Engine (CORE)
• New Recovery Café Development Costs
• Recovery Support Services (SABG) Billing Summary
• Substance Use Disorder Peer Recovery Services Monthly FTE Report
• WASEC Recovery Support Systems Monthly Report

Quarterly

•  Contractor Profile Update

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)
• MIDD Annual Narrative Report
• WASEC Recovery Support Systems Annual Report

Invoice Form(s)

• Recovery Innovation, Inc./RI International Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• E&T Census Report
• E&T Admission Denial Log
• E&T Seclusion and Restraint Report
• IRT Census Report

Quarterly

• Clinician Roster
• Contractor Profile
• Third Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Refugee Women’s Alliance Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Domestic Violence Behavioral Health (DV-BH) Services Monthly Summary Report
• DV-BH Services Monthly Staffing Report
• DV-BH Services MIDD data to Client Outcome Reporting Engine (CORE)
• Monthly Interpreter Detail (if applicable)

Quarterly

• Clinician Roster (due March 6 • June 7 • September 6 • December 6)
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)
• MIDD Annual Narrative Report

Invoice Form(s)

• Ryther Center Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Juvenile Justice Assessment Team (JJAT) FTE Report
• Medication-Assisted Treatment (MAT)- Shelters/Encampments Services Monthly Supplies and Equipment Billing Report
• MAT-Shelters/Encampments Services Monthly Staffing Report
• MAT Shelters/Encampments Services MIDD data to Client Outcome Reporting Engine (CORE)
• Mental Health Outpatient: Infant-Child Expanded Assessment Reimbursement Form
  
• New Journeys Demonstration Project Progress Form
• Youth Support Services (YSS) Narrative Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• New Journeys Demonstration Project Quarterly Reconciliation Report
• Third Party Payment Report
• YSS Quarterly Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

• Seadrunar Center Invoice Forms

Required Reports & Timeframes

Monthly

• SUD Residential Census Report

Quarterly

• Clinician Roster
• Contractor Profile Update

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Disaster Recovery and Business Continuity Plan Update(s)

Invoice Form(s)

• Sea Mar Community Health Centers Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Intensive Step-Down Program monthly census
• SUD Residential Monthly Census Report-Adult Intensive Inpatient
• SUD Residential Monthly Census Report-Youth Intensive Inpatient
• SUD Residential Monthly Census Report-Youth Recovery House

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Seattle Childrens Research Institute Invoice Forms

Required Reports and Timeframes

Monthly

• Community Driven BH Services MIDD data

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Invoice Form(s)

• Seattle Counseling Services Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Hepatitis AIDS Substance Abuse Program (HASAP) FTE Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report
• HASAP Quarterly Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance and Endorsement
• Client Success stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)
• Participate in County’s Annual Report to DBHR for HASAP

Invoice Form(s)

• Seattle Indian Health Board Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System

Quarterly

• Clinician Roster
• Third Party Payment Report
• Contractor Profile Update

Semi-Annual

• None

Annual/Other

• Audited Financial Statements
• Certificate of Insurance and Endorsement
• Client Success stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Seattle Public Schools Invoice Forms

Required Reports and Timeframes

Monthly

• HYCAN Monthly Actual Expenditure Report and Summary 2021-2023
• SWSYA Monthly Actual Expenditure Report and Summary 2021-2023
• Minerva Monthly Report
• YSS Narrative Report
• 2021-2022 Seattle SBIRT Financial Report

Quarterly

• YSS Quarterly Report
• Minerva Quarterly Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance and Endorsement
• Client Success Stories (Upon Request)

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System

Quarterly

• Clinician Roster
• Quarterly Update Package
• Third Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update

Invoice Form(s)

• The Seven Challenges Invoice Forms

Required Reports and Timeframes

Monthly

• Seven Challenges Monthly Report (including materials purchased and training sessions delivered to Providers

Quarterly

• None

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance and Endorsement
• Annual Fidelity/ Support Meeting Summary

Invoice Form(s)

• Somali Health Board Invoice Forms

Required Reports and Timeframes

Monthly

• Community Driven BH Services MIDD data 

Quarterly

• Contractor Profile Update-MIDD-Local Version

Semi-Annual

• N/A

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report

Invoice Form(s)

• Snoqualmie Indian Tribe Invoice Forms

Required Reports and Timeframes

Monthly

• None

Quarterly

• Contractor Profile Update
• Tribal Substance Use Disorder Treatment Services Report
• Tribal Mental Health Services Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

Invoice Form(s)

• Sound Invoice Forms

Required Reports and Timeframes

Monthly

• Adult Crisis Services:
  • Adult Crisis Services Report
• Assisted Outpatient Services Program:
  • AOSP Monthly Tracking Form
• CDVRT:
  • CDVRT Monthly Summary Report
• Enhanced Nursing Facility Partnership Project at Benson Heights:
  • Benson Heights Rehabilitation Center Census Log
• KC SUD Outpatient Monthly Transportation Back-up (as needed)
• Long-Term Rehabilitation Services
  • LTR Billing Report Services Monthly Summary
• Supervised Living
  • SL Billing Report Services Monthly Summary
• Reaching Recovery
  • FIRST Report
  • Reaching Recovery Housing Status Log
  • IDDT Tracking Report
• South King County Housing First
  • South King County Housing First Monthly Move-In Report
  • South King County Housing First Monthly Move-Out Report
• Standard Supportive Housing Program
  • Standard Supportive Housing Report
• Transition Support Program
  • TSP Monthly Staffing Report
  • TSP Linkage Report
• PATH
• PATHHMIS Report
• Wraparound
  • Wraparound Contract Summary
  • Wraparound Monthly Flex Fund Expenditures
  • Wraparound Flex Fund Request Form
  • Wraparound Flex Fund Request Interpreter Form
  • Wraparound Flex Fund Request Special Event Form
  • Wraparound Data Outcome Tool and Caregiver Strain Questionnaire
• Data Certification Letter
• Data and Encounter Submission to the BHRD Management Information System

Quarterly

• PATH Quarterly Report
• PATH Performance Report
• Reaching Recovery Marker Inventory (for all program participants)
• Reaching Recovery Consumer Recovery Measure (for all program participants)
• SEP Quarterly Report
• SEP Supplemental Quarterly Report (as needed)
• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

N/A

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• MIDD Annual Narrative Report
• Closure Dates Report
• Client Success Stories (upon request)
• Disaster Recovery Business Continuity Plan Update

Invoice Form(s)

• Southwest Youth and Family Services Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Mental Health Outpatient: Infant-Child Expanded Assessment Reimbursement Form

Quarterly

• Clinician Roster(due March 6 • June 7 • September 6 • December 6)
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• St. Anne Hospital Invoice Forms

Required Reports and Timeframes

Monthly

• SBIRT-EDS FTE Report
• SBIRT-EDS MIDD data spreadsheet uploaded to Client Outcome Reporting Engine (CORE)

Quarterly

• None

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance and Endorsement
• Annual Overall ED Admissions Demographic Report

Invoice Form(s)

• St. Francis Hospital Invoice Forms

Required Reports and Timeframes

Monthly

• SBIRT-EDS FTE Report
• SBIRT-EDS MIDD data spreadsheet uploaded to Client Outcome Reporting Engine (CORE)

Quarterly

• None

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance and Endorsement
• Annual Overall ED Admissions Demographic Report

• Specialty Services II Invoice Form

Required Reports & Timeframes

Monthly

• SUD Residential Census Report

Quarterly

• Clinician Roster
• Contractor Profile Quarterly Update

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Tacoma-Pierce County Health Department Invoice Forms

Required Reports and Timeframes

Monthly

• Data and encounter submission to the BHRD Management Information System
• Data Certification

Quarterly

• Clinician Roster
• Contractor Profiler Update
• Third Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Telecare King County Evaluation and Treatment Invoice Forms

Required Reports and Timeframes

Monthly

• E&T Census Report
• E&T Admission/Denial Log
• E&T Discharge Planner Report
• E&T Seclusion and Restraint
• HARPS Housing Bridge Subsidy (as needed)
• PACT Monthly Report
• PACT CBRA Monthly Report

Quarterly

• Clinician Roster
• Third Party Payment Report
• Contract Profile Update

Semi-Annual

• PACT Transition Assessment Scale

Annual/Other

• Audited Financial Statement*
• Closure Date Report
• Certificate of Insurance & Endorsement*
• Client Success Stories (upon request)
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• Therapeutic Health Services Invoice Forms

Required Reports and Timeframes

Monthly

• Data and encounter submission to the BHRD Management Information System
• Data Certification
• MST FTE Staffing Report
• MST Status Report
• PPW Report
• WASEC Non-Medicaid MAT Program Monthly Report
• YEP Status Report

Quarterly

• Clinician Roster

• Contractor Profile Update

• Third Party Payment Report

Semi-Annual

• N/A

Annual/Other

• Audited Financial Statement
• Certificate of Insurance and Endorsement
• Client Success stories (Upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)
• MST Summary Demographic Report
• YEP Summary Demographic Report
• WASEC Non-Medicaid MAT Program Annual Report

Invoice Form(s)

• Transitional Resources Invoice Forms

Required Reports and Timeframes

Monthly

• Adult Inpatient Diversion Bed Monthly Report
• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Intensive Community Support and Recovery Program (ICSRP) Census
• ICSRP Engagement Log
• Long-Term Residential (LTR) Monthly Billing Report Services/Census

Quarterly

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Closure Dates Report
• Client Success Stories (upon request)
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Forms

• Triumph Treatment Services Invoice Forms

Required Reports and Timeframes

Monthly

• SUD Residential Census Report and MAT Log

Quarterly

• Clinician Roster
• Contractor Profile Update

Semi-Annual

• None

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Disaster Recovery and Business Continuity Plan Update(s)

Invoice Form(s)

• Valley Cities Counseling and Consultation Invoice Forms

Required Reports and Timeframes

Monthly

• Assisted Outpatient Services Program (AOSP) Monthly Crisis Housing Voucher Log 
• Adult Crisis Services Report
• Adult Crisis Services Monthly Crisis Housing Voucher Log
• Data Certification Letter
• Evaluation and Treatment Census Report
• E & T Monthly Admission Denial Log
• E & T Seclusion and Restraint Report
• Family Treatment Court Wraparound FTE Report
• Low Barrier Buprenorphine FTE Report
• Mental Health First Aid FTE Report
• Mental Health First Aid Monthly Performance Report
• New Journeys Demonstration Project Progress Form
• Standard Supportive Housing (SSH) Monthly Report
• SUD Residential Census Report
• Secure Withdrawal Management Census Report
• Withdrawal Management Census Report
• Wraparound Monthly Summary Report
• Wraparound – Flex Fund Expenditures Report
• Wraparound Flex Fund Request
• Wraparound Flex Fund Request – Interpreter Form
• Wraparound Flex Fund Request – Special Event
• SSH Rental Assistance monthly documentation

Quarterly

• Clinician Roster
• Contractor Profile Update
• Supported Employment Program (SEP) Quarterly Report
• SEP Quarterly Report – Supplemental (as needed)
• Low-Barrier Buprenorphine Treatment Expansion Quarterly Report
• New Journeys Demonstration Project Quarterly Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement
• Closure Dates Report
• Client Success Stories (upon request)
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• VARSA Invoice Forms

Required Reports and Timeframes

Monthly

• VARSA Monthly Actual Expenditure Report and Summary 2021-2023
• Minerva Monthly Report

Quarterly

• Minerva Quarterly Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

Invoice Form(s)

• Vashon Youth and Family Services (VYFS) Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)

• WAPI Community Services Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• Youth Support Services (YSS) Narrative Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Third Party Payment Report
• YSS Quarterly Report

Semi-Annual

• None

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement
• Client Success Stories (upon request)
• Closure Dates Report
• Disaster Recovery and Business Continuity Attestation and Plan Update(s)

Invoice Form(s)

• Washington Department of Veteran Affairs (WDVA) Invoice Forms

Required Reports and Timeframes

Monthly

• Veterans Flex Fund Expenditure Report
• Veteran Staffing Report

Quarterly

• None

Semi-Annual

• None

Annual/Other

• None

Invoice Form(s)

• WCHS Invoice Forms

Required Reports and Timeframes

Monthly

• Data and encounter submission to the BHRD Management Information System
• Data Certification Letter

Quarterly

• Clinician Roster
• Third Party Payment Report
• Contractor Profile Update

Semi-Annual

• N/A

Annual/Other

• Audited Financial Statement
• Certificate of Insurance and Endorsement
• Client Success stories (upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)

Invoice Form(s)