Attachment J-1 Billing Authorization.pdf
PDF 166 KB Posted
- Attached to
- Residential Drug Treatment Services (FY 2024)
- Solicitation number
- 9594CS24R0022
About this file
This document contains a billing authorization and details of a federal contract opportunity for residential drug treatment services. The billing authorization is for a specific offender referral to a treatment vendor for up to 28 days of substance use disorder treatment. It provides the offender's name, ID number, planned admission and discharge dates, pick-up details, and maximum allowable invoice amount. The related federal contract opportunity is soliciting residential drug treatment services within a 30-mile radius of Washington, D.C. for men and women through placements of up to 30 days at a contractor's facility. The objective is to address offender substance use disorders and risks while promoting rehabilitation and reentry. An updated authorization will cover any approved placement extensions.
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Text version
Attachment No. J-1 Billing Authorization
MEMORANDUM
To: Treatment Vendor
Through: Program Analyst, COR
From: Referral Placement Coordinator
Date: _______________________
Subject: Billing Authorization
Enclosed please find a referral package for John Doe (PDID = 123456) who is in need of treatment. The duration of treatment for this Patient shall not exceed 28 days.
You are required to complete the attached admission confirmation from within 24 hours of the scheduled admission date. The admission confirmation must be emailed to the Treatment
Referral Coordinator at rpt@csosa.gov.
Name PDID
Number
Admission
Date
Discharge Date
Shall Not Exceed
Pick-Up
Location/Time
Obligation/Invoice
Shall Not Exceed
John Doe 123456 11/6/05 12/4/06 601 Indiana
10:00 am
$100.00
No later than 24 hours after the scheduled pick-up, please email this form back to me at rpt@csosa.gov to indicate reasons for non-admission.
Thank you.
Email to rpt@csosa.gov
To: Referral Placement Coordinator
From: Treatment Vendor
Date: _____________________________________________
Name PDID
Number
Vendor Treatment Status –
Admitted? Yes or
No If no, indicate reason
John Doe 123456 Your organization
30 days 601 Indiana
10:00 am
File details come from the government source that posted it. Updated .