Invoice Form(s)

• American Behavioral Health Systems Invoice Forms

Required Reports and Timeframes

Monthly

• SUD Acute Withdrawal Management Census Report
• SUD Secure Withdrawal Management Census Report
• SUD Adult 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)

• 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
• Forensic Treatment Services Denial Report
• Forensic Treatment Subsidized Client Report
• Older Adult SUD FTE Report
• Older Adult SUD Performance Report
• Pretrial Assessment and Linkage Services (PALS) Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Supported Employment Program (SEP) Quarterly Report
• Third Party Payment Report
• CCAP Brief Intervention Quarterly 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
• 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

• SBIRT Financial Report
• Monthly Actual Expenditure Report Form and Summary 2022-2023 
• Minerva Monthly Report

Quarterly

• Minerva Quarterly Report

Semi-Annual

• SBIRT Narrative Report Sept-Dec
• SBIRT Narrative Report Jan-Aug

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

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)

• 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 Reimbursement Form
  
• Pregnant and Parenting Women (PPW) On-Site Child Care Services Report
• Wraparound – Flex Fund Expenditures Report
• Wraparound Flex Fund Request
• Wraparound Flex Fund Request – Interpreter Form
• Wraparound Flex Fund Request – Special Event
• Youth Support Services (YSS) Narrative Report
• Wraparound Data Outcome Tool Caregiver Strain Questionnaire submission to the Client Outcome and Reporting Engine (CORE)

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 (DRBC) Plan Update(s)

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

Annual/Other

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

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
• Legal Intervention and Network of Care (LINC) Client Narrative
• LINC Client Record (LINC & TSH)  
• LINC Enrollee and Referral Tracking
• LINC Monthly Report Log
• Long-Term Residential (LTR) Services Reimbursement Request & Billing Report Services Summary
• Supervised Living (SL) Services Reimbursement Request Billing Report Services Summary
• Seattle Municipal Court (SMC) Competency Boundary Spanner Report
• Standard Supporting Housing (SSH)-Intensive Supportive Housing (ISH) Monthly Report

Quarterly

• LINC & TSH- provide information as requested by the county for HCA Trueblood Diversion narrative report 
• Clinician Roster 
• Contractor Profile Update
• Third Party Payment Report

Bi-monthly

• Continuing Stay Review for Long Term Rehabilitation

Annual/Other

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

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)

• 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)
• Crisis Line Caller Data Report
• 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

Annual/Other

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

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
• Community Outreach and Advocacy Team (COAT) monthly staff 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
• Homeless Outreach, Stabilization and Treatment (HOST) KCMHP Transfer Report
• Low Barrier Buprenorphine Service Expansion FTE Summary Report
• MCT Monthly Report
• Morrison Housing Report
• PACT Monthly HARPS Participant Log
• PACT Monthly Report
• PATH HMIS Report
• PATH HMIS Performance Report
• Pathfinder Peer Project HMIS Report
• Pathfinder Rental Assistance Report
• WASPC Grant Monthly Reporting Requirements

Quarterly

• 1811 ICM Project Narrative Report
• Clinician Roster
• Contractor Profile Update
• CSC Quarterly Expenditures Report, Per Program Component
• HOST Quarterly Report
• Low-Barrier Buprenorphine Treatment Expansion Report
• MCT Quarterly Report
• PATH Performance Report/PATH FTE Report
• Peer Pathfinder Implementation Report
• SEP Quarterly Report
• Third Party Payment Report

Semi-Annual

• PACT Transition Assessment Scale
• COAT- provide information as requested by the county for HCA Trueblood Diversion narrative report. 

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)

Required Reports and Timeframes

Monthly

• 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)
• Closure Dates Report
• Disaster Recovery Business Continuity (DRBC) 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 rev Jan. 2023 v2
• Monthly Minerva Report

Quarterly

• Quarterly Minerva 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
• 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
• Recovery Navigator Program (RNP) State-HCA Expenditure Report
• RNP Crisis Housing Voucher Log
• State-HCA RNP Data Collection Tool V4
• Intensive Care Management VITAL Housing Log

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)

• 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)

• 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)

• 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)

• 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

• Assisted Outpatient Services Program (AOSP) Agency Tracking Form
• Data Certification Letter
• 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 
• Involuntary Treatment Triage
  • Involuntary Treatment Triage Report
• Peer Bridger Program
  • Peer Bridger Program FTE Report 
  • Peer Bridger Program Voucher Report 
• SBIRT Emergency Department Services
  • SBIRT-EDS Monthly Narrative Report 
• Substance Use Disorder (SUD) Next Day Appointment (NDA) Referral Tracking Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Emergency Department/Psych Emergency Services Care Manager
  • ED PES Care Manager Log
• Supported Employment Program (SEP)
  • SEP Quarterly Report (sent to secure server)
• 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)

• Family Faces Intensive Care Management
  • Provide specific information for the MIDD Annual Report only as requested by the county
  • Annual Veterans, Seniors, and Human Services Levy report
• Involuntary Treatment Triage
  • Involuntary Treatment Triage Annual Report
• SBIRT Emergency Department Services
  • Annual Overall ED Admissions Demographic Report
  • 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

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

Quarterly

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

Semi-Annual

• None

Annual/Other

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

Invoice Form(s)

• Highline School District Invoice Forms

Required Reports and Timeframes

Monthly

• SBIRT Financial Report

Quarterly

• None

Semi-Annual

• SBIRT Narrative Report Sept-Dec
• SBIRT Narrative Report Jan-Jun

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

Invoice Form(s)

• IKRON Invoice Forms

Required Reports and Timeframes

Monthly

• Data Certification Letter
• Data and encounter submission to the BHRD Management Information System
• PACT Monthly HARPS Participant Log
• PACT Monthly Report
• PACT Community Behavioral Health Rental Assistance (CBRA) Monthly Log

Quarterly

• Clinician Roster
• Contractor Profile Update
• Supported Employment Program (SEP) Quarterly Report
• 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)

• 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)

• Institute for Family Development Invoice Forms

Required Reports and Timeframes

Monthly

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

Quarterly

• None

Semi-Annual

• None

Annual/Other

• FFT Client Demographic Report

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)

• Kelley-Ross Pharmacy Invoice Forms

Required Reports and Timeframes

Monthly

• Laced and Lethal Campaign Report

Quarterly

• None

Semi-Annual

• None

Annual/Other

• Audited Financial Statements
• Certificate of Insurance & Endorsement

Invoice Form(s)

• Kennedy Catholic High School Invoice Forms

Required Reports and Timeframes

Monthly

• SBIRT Financial Report

Quarterly

• None

Semi-Annual

• SBIRT Narrative Report Sept-Dec
• SBIRT Narrative Report Jan-June

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

Invoice Form(s)

• Kent School District Invoice Forms

Required Reports and Timeframes

Monthly

• SBIRT Financial Report

Quarterly

• None

Semi-Annual

• SBIRT Narrative Report Sept-Dec
• SBIRT Narrative Report Jan-June

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

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
• 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)

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)

• Mercer Island School District Invoice Forms

Required Reports and Timeframes

Monthly

• SBIRT Financial Report

Quarterly

• None

Semi-Annual

• SBIRT Narrative Report Sept-Dec
• SBIRT Narrative Report Jan-Jun

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

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
• Mental Health Outpatient: Infant-Child Expanded Assessment Reimbursement Form
• PACT Monthly HARPS Participant Log
• 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
• Continuing Stay Review for Intensive Community Support and Recovery Program

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 
• 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)

• Northshore School District Invoice Forms

Required Reports and Timeframes

Monthly

• SBIRT Financial Report

Quarterly

• None

Semi-Annual

• SBIRT Narrative Report Sept-Dec
• SBIRT Narrative Report Jan-June

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

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

• Recovery Support Services Reimbursement Summary
• Recovery Navigator Program (RNP) State-HCA Expenditure Report
• RNP Crisis Housing Voucher Log

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 Report
• Sobering Adult Case Management Monthly Status Report
• Correction-Based SUD Tx Svcs Monthly Staffing Report
• SUD Residential Census Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• Sobering Services Fiscal Reconciliation 

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)
• Sobering Adult Case Management Summary Demographic Report
• Corrections-based SUD tx svcs Flex Fund Expenditures Reports

Invoice Form(s)

• Public Defender Association Invoice Forms

Required Reports and Timeframes

Monthly

• LEAD Monthly Report
• MIDD data 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)

• Puget Sound Educational Service District Invoice Forms

Required Reports and Timeframes

Monthly

• CDFY Monthly Actual Expenditure Report and Summary
• Minerva Monthly Report
• PSESD Recovery School Narrative and Expense Report
• PSESD Recovery School Transaction Recap 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

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

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
• Youth Support Services (YSS) Narrative Report
• Zero Suicide Initiative Pilot Program (ZSIPP) Narrative Report

Quarterly

• Clinician Roster
• Contractor Profile Update
• 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)

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
• Intensive Step-Down Program Continuing Stay Review 
• 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)

• 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)

• 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 
• SWSYA Monthly Actual Expenditure Report and Summary 
• Minerva Monthly Report
• YSS Narrative Report
• SBIRT Financial Report
• SPS Recovery School Coordinator Monthly Narrative Report
• SPS Recovery School Coordinator Monthly Payroll Summary and Expenditure Report

Quarterly

• YSS Quarterly Report
• Minerva Quarterly Report

Semi-Annual

• SBIRT Narrative Report Sept-Dec
• SBIRT Narrative Report Jan-June

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

• None

Quarterly

• None

Semi-Annual

• None

Annual/Other

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

Invoice Form(s)

• Skykomish School District Invoice Forms

Required Reports and Timeframes

Monthly

• SBIRT Financial Report

Quarterly

• None

Semi-Annual

• SBIRT Narrative Report Sept-Dec
• SBIRT Narrative Report Jan-June

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

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)

• Snoqualmie Valley School District Invoice Forms

Required Reports and Timeframes

Monthly

• SBIRT Financial Report

Quarterly

• None

Semi-Annual

• SBIRT Narrative Report Sept-Dec
• SBIRT Narrative Report Jan-June

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

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)

• Sound Invoice Forms

Required Reports and Timeframes

Monthly

• Adult Crisis Services:
  • Adult Crisis Services Report
  • Adult Crisis Services SUD - Next Day Appointment (NDA) 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)
  • LTR Billing Report Services Monthly Summary
• Reaching Recovery
  • Reaching Recovery Housing Status Log
• 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 Exit Disposition Report
• PATH
  • PATH HMIS 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: CORE
  • MIDD Wraparound Referral & Discharge Log
• Data Certification Letter
• Data and Encounter Submission to the BHRD Management Information System

Quarterly

• PATH Quarterly Report
• PATH Performance Report
• SEP Quarterly Report
• 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 (upon request)
• Closure Dates Report
• Client Success Stories (upon request)
• Disaster Recovery Business Continuity Plan Update
• Standard Supportive Housing Re-Authorization Form

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)

• 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)
• 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
• Provide specific information for the MIDD annual Report as requested by the County

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)

• Tacoma School District Invoice Forms

Required Reports and Timeframes

Monthly

• SBIRT Financial Report

Quarterly

• None

Semi-Annual

• SBIRT Narrative Report Sept-Dec
• SBIRT Narrative Report Jan-June

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement

Invoice Form(s)

• Telecare King County Evaluation and Treatment Invoice Forms

Required Reports and Timeframes

Monthly

• Evaluation and Treatment (E&T) Census Report
• E&T Admission/Denial Log
• E&T Discharge Planner Report
• E&T Seclusion and Restraint
• Program of Assertive Community Treatment (PACT) Monthly HARPS Participant Log
• PACT Community Behavioral Health Rental Assistance (CBRA) Monthly Report
• PACT Monthly Report

Quarterly

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

Semi-Annual

• PACT Transition Assessment Scale

Annual/Other

• Audited Financial Statement*
• Certificate of Insurance & Endorsement*
• Client Success Stories (upon request)
• Closure Date Report
• 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
• Multisystemic Therapy (MST) FTE Staffing Report
• MST Monthly Status Report
• Pregnant Parenting Women (PPW) Report and On-Site Childcare Services Report
• Washington State Emergency COVID-19 (WASEC) Non-Medicaid Medication-Assisted Treatment (MAT) Program Monthly Report
• Youth Support Services (YSS) Status 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 and Endorsement
• Client Success stories (Upon request)
• Closure Dates Report
• Disaster Recovery Business Continuity Plan Update(s)
• MST 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

Bi-Monthly

• Continuing Stay Reviews for Long Term Rehabilitation

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)

• Tukwila School District Invoice Forms

Required Reports and Timeframes

Monthly

• SBIRT Financial Report

Quarterly

• None

Semi-Annual

• SBIRT Narrative Report Sept-Dec
• SBIRT Narrative Report Jan-June

Annual/Other

• Audited Financial Statement
• Certificate of Insurance & Endorsement