Attachment J-8 CSOSA Treatment Monthly Invoice.pdf

This is a monthly invoice template for the Court Services and Offender Supervision Agency (CSOSA) treatment services contract. The form is designed for contractors to submit reimbursement claims for treatment services provided to individuals under CSOSA supervision.

The invoice template requires contractors to provide identifying information including contractor name, address, contract number, Tax ID number, Document Control Number (DCN), invoice number, date of submission, and the month being billed. The services rendered section contains columns for tracking individual patient information: PDID (Patient Identifier) number, admission date, discharge date or projected discharge date, unit cost per service, units received, and total patient cost. The template includes multiple rows to accommodate multiple patients per invoice and a total monthly charges line to aggregate all billing for the submission period. This form serves as the standard billing document for CSOSA treatment contract reimbursement purposes.