Follow the steps to accurately complete the invoice.

1. Click ‘Get Form’ button to access the LTCFEDS Informal Caregiver Invoice and open it in your preferred editor.
2. Begin by entering the insured’s claim ID and their full name, followed by the informal caregiver’s name in the designated fields.
3. For each date of service provided, enter one date per line. Make sure to format the date correctly as mm/dd/yy.
4. Fill in the 'Time in' and 'Time out' for each service on that day, clearly indicating a.m. or p.m. Remember to round the time to the nearest quarter hour.
5. Calculate and enter the total hours worked along with the approved hourly charge and daily total for each corresponding date of service.
6. Input the total reimbursement amount you are requesting at the end of your entries.
7. Mark an ‘X’ in the appropriate boxes next to each activity of daily living service you provided, ensuring accurate record-keeping for all services rendered.
8. Enter the check or transaction number for each date of service. Attach the necessary proof of payment, ensuring that it meets the outlined requirements.
9. Make sure the total amount requested matches the proof of payment provided, and that it is a valid form of payment.
10. After services are rendered, both the informal caregiver and the insured or their legal representative must sign and date the invoice.
11. If the informal caregiver and legal representative are the same person, include an additional signature from a third party to attest to the services rendered.
12. Finally, review the entire invoice for accuracy, then save your changes. You may download, print, or share the completed form as needed.

Complete your LTCFEDS Informal Caregiver Invoice online today for a seamless reimbursement process.