Exhibit_A.1_-_Invoice_Sample_2025__.pdf

This is an invoice sample document prepared for the County of Volusia's Emergency Medical Services (EMS) Division in Florida for billing and invoicing services related to countywide ambulance and medical services. The sample invoice template demonstrates the required format and data elements that the contractor must utilize when processing billings for services that are billable to Medicare and/or Medicaid. The document establishes the structural and informational requirements that invoices must follow to ensure compliance with billing standards and proper documentation of EMS services rendered to patients eligible for government healthcare programs.

The invoice sample serves as a template specification document that establishes the contractor's invoicing system requirements and capabilities. The contractor selected for this engagement must demonstrate the ability to generate invoices conforming to this sample format while maintaining compliance with HIPAA and HITECH Act requirements governing protected health information and electronic health records. This document is a critical component of the ITB evaluation criteria, as it allows prospective bidders to understand the specific invoicing standards and technical specifications expected in service delivery and establishes baseline requirements for the contractor's billing software, data management systems, and output documentation standards.