Get Dshs Form B 13

Filling out the Dshs Form B 13 is an essential process for submitting reimbursement requests to the Texas Department of Health. This guide provides a clear and supportive approach to completing the form accurately and efficiently in an online format.

Follow the steps to successfully complete your Dshs Form B 13 online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Enter the order date in Section 6. This date refers to when the voucher is being submitted for payment.
3. In Section 9, input the Payee I.D. No., which is the 14-digit code assigned to the Performing Agency by the State Comptroller's Office.
4. Fill in the Document Amount in Section 13, indicating the net amount you are billing the Texas Department of Health for the specified period.
5. Provide the payee name and address in Section 14. Make sure this matches the details associated with the Payee I.D. No. to avoid payment delays.
6. In Section 19, enter the Service or Delivery Date. This should correspond to either the month the costs were incurred or the month payment was made.
7. Complete Section 20 by giving a detailed description of the goods or services provided.
8. Indicate whether it is a Reimbursement or Advance Statement, along with the contract term, while then entering the relevant TDH Program name and type of entity.
9. Fill out Sections 21 & 22 with quantity and unit price for fee-for-service contracts.
10. Calculate and provide total expenses in Section 23, subtracting program income, non-TDH funding, refunds, and any advance repayments to determine the net reimbursement requested.
11. Finally, enter the contact name and phone number of the responsible person for the account in Section 24.
12. Review all completed sections for accuracy, then save your changes, download, print, or share the form as needed.

Complete your Dshs Form B 13 online today to streamline your reimbursement process.