Provider Invoices & Reporting Requirements

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
Weekly: Wraparound/WISe Referral/Screen Requests, Referrals Source, Enrollees, and Pending List

Childhaven

Invoice Form(s)

Childhaven Invoice Form

Required Reports & Timeframes

Monthly

Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
Therapeutic Child Care Monthly Service Report
Wraparound/WISe Closures & Staffing Report
Wraparound/WISe Data Outcome Tool and Caregiver Strain Questionnaire
Wraparound Monthly Flex Fund Expenditure Report
Wraparound/WISe Monthly Summary & Training Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report
Current State of Washington Child Care License (for each branch site)
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
Weekly Reports: Wraparound/WISe Referral/Screen Requests, Referrals Source, Enrollees, and Pending List

City of Bothell

City of Bothell Invoice Form

Coalition Ending Gender-Based Violence

Invoice Form(s)

Coalition Ending Gender-Based Violence Invoice Form

Required Reports & Timeframes

Monthly

Quarterly

Contractor Profile Update

Semi-Annual

None

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
DV-BH Services Annual Outcomes Report

Coleman Family Services

Coleman Family Services Invoice Form

Community House Mental Health Agency

Invoice Form(s)

Community House Mental Agency Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
Legal Intervention & Network of Community Care (LINC) Client Record
LINC Monthly Report Log
LINC Quarterly Aggregate Data (Monthly Report)
Long-Term Residential (LTR) Services Reimbursement
LTR Residential Invoice Report (Client Summary List in Excel Format)
Supervised Living (SL) Billing Services Reimbursement
SL Residential Invoice Report (Client Summary List in Excel Format)
Standard Supportive Housing/Intensive Supported Housing (SSH/ISH) Monthly Report
Trueblood Client Record

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Community Psychiatric Clinic

Community Psychiatric Clinic Invoice Form

Consejo Counseling & Referral Services

Invoice Form(s)

Consejo Counseling & Referral Services Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Cowlitz Tribal Treatment

Invoice Form(s)

Cowlitz Tribal Treatment Invoice Forms

Required Reports & Timeframes

Quarterly

Tribal Substance Use Disorder Treatment Services
Mental Health for Children, Adults, Older Adults, and Families

Semi-Annual

Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Crisis Connections

Invoice Form(s)

Crisis Connections Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
Emergency Telephone Services
- Daily Crisis Log
- Daily Crisis Log - CC Business Line
- Daily Crisis Log - CC Crisis Line
- Crisis Line Wait Time Intervals Monthly Reports
- Monthly Crisis Line Caller Data Report
- Next Day Appointment Monthly Report
- Mobile Crisis Team Monthly Dispatch Report
- CCPAR Line Volume & Outcomes Report
- CCPAR Business Line Report
Patient Placement Coordination
- PPC Placement Outcomes Summary Report
- PPC Call Volumes Summary Report
Telephone Service for Crisis and Commitment Services
- TSCCS Telephone Summary Report (Professional Line Report)
- TSCCS Triage Summary Report (Public Line Report)
- Sheena's Law Report
Warm Line
- Warm Line Monthly Volunteer Report
- Warm Line Monthly Call Report
- Warm Line Profit & Loss Report
- Warm Line Trial Balance Report

Quarterly

Clinician Roster
Contractor Profile Update
Emergency Telephone Services
- Quarterly Access Report
- Quarterly Crisis Line Caller Data Report
- Quarterly CCPAR Crisis Line Report
- Quarterly CCPAR Business Line Report
Low-Barrier Buprenorphine
- Low-Barrier Buprenorphine Treatment Expansion Quarterly Report
Third-Party Payment Report
Warm Line
- Warm Line Quarterly Access Report
- RH Call Status Report
- Caller Data Report: Warm Line Quarterly Report
- Quarterly Reconciliation Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
Warm Line
- Warm Line Yearly Access Report

Daybreak Youth Services

Invoice Form(s)

Daybreak Youth Services Invoice Forms

Reporting Requirements and Timeframes

Monthly

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Domestic Abuse Women's Network (DAWN)

Invoice Form(s)

Domestic Abuse Women's Network Invoice Form

Required Reports & Timeframes

Monthly

DV-BH Services Monthly Staffing Report
DV-BH Services Monthly Summary Report
DV-BH Services MIDD Evaluation Data Report

Quarterly

Contractor Profile Update

Annual/Other

Audited Financial Statement
Certificate of insurance & Endorsement
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
DV-BH Services Annual Outcomes Report

Downtown Emergency Services Center (DESC)

Invoice Form(s)

Downtown Emergency Services Center Invoice Forms

Required Reports & Timeframes

Monthly

1811 Intensive Case Management (ICM) FTE Report
COVID Relief Fund Report
Crisis Respite Program (CRP) Monthly Report
CRP Monthly Census Log
CRP Referrals Denied Monthly Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
Homeless Outreach, Stabilization, and Treatment (HOST) Transition Monthly Report
HARPS SUD-Only Subsidy Log
Morrison Housing Report
Peer Pathfinder HMIS Monthly Report
Project for Assistance in Transition from Homelessness (PATH) Monthly Report
Specialty Employment Provider (SEP) Monthly Report
Specialty Employment Provider (SEP) Supplemental Monthly Report (as needed)
SHARP Caseload Report

Quarterly

1811 ICM Quarterly Project Narrative Report
Clinician Roster
Contractor Profile Update
HARPS Participant Log
HARPS Quarterly Report
HOST Quarterly Report
Low-Barrier Buprenorphine Treatment Expansion Quarterly Report
PATH Quarterly Performance Report
Peer Pathfinder Quarterly Implementation Report
Specialty Employment Provider (SEP) Quarterly Report
Third-Party Payment Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
CRP Annual Staffing Plan
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
PATH Annual Report
SEP MIDD Client Success Stories (as requested)

The Dove Project

The Dove Project Invoice Form

Evergreen Healthcare

Invoice Form(s)

Evergreen Healthcare Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System

Quarterly

Third-Party Payment Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Evergreen Recovery Centers

Invoice Form(s)

Evergreen Recovery Centers Invoice Forms

Required Reports & Timeframes

Monthly

SUD Residential Census Report
SUD Withdrawal Management Census Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Evergreen Treatment Services

Invoice Form(s)

Evergreen Treatment Services Invoice Form

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
MAT Out-of-County Report
Reentry Case Management Services Staffing Report
SUD Mobile Medical Van Report
WASEC Non-Medicaid MAT Program Monthly Report

Quarterly

Clinician Roster
Contractor Profile Update
SUD Mobile Medical Van Evaluation Report
Third-Party Payment Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Excelsior Youth Centers

Invoice Form(s)

Excelsior Youth Centers Invoice Form

Required Reports & Timeframes

Monthly

SUD Residential Census Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Friends of Youth

Invoice Form(s)

Friends of Youth Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
Wraparound Contract Monthly Summary
Wraparound Monthly Flex Fund Expenditures
Wraparound Flex Fund Request Form
Wraparound Flex Fund Request Interpreter Form
Wraparound Flex Fund Request Special Event Form
Youth Support Services (YSS) FTE Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

GBS Northwest

GBS Northwest Invoice Form

Guided Pathways

Invoice Form(s)

Guided Pathways Invoice Form

Required Reports & Timeframes

Monthly

Family Support Organization Monthly Progress Report
FSO MIDD Evaluation Data Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
GPS Workplan and Year-End Summary

Harborview Allied & Ambulatory Services

Invoice Form(s)

Harborview Allied & Ambulatory Services Invoice Forms

Required Reports & Timeframes

Monthly

SA-BH Services Monthly Summary Report
SA-BH Services MIDD Evaluation Data Report

Quarterly

Contractor Profile Update

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
SA-BH Services Annual Outcomes Report

Harborview Behavioral Health Services

Invoice Form(s)

Harborview Behavioral Health Services Invoice Forms
Harborview Outpatient Mental Health & Addiction Invoice Form

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
Emergency Department/Psych Emergency Services Care Manager
- ED PES Care Manager Monthly FTE Report
- ED PES Care Manager Monthly Voucher Detail Report
Involuntary Treatment Triage
- Involuntary Treatment Triage Monthly Report
Peer Bridger Program
- Peer Bridger Monthly FTE Report
- Peer Bridger Monthly Voucher Report
Screening, Brief Intervention, and Referral to Treatment (SBIRT) Emergency Department Services
- SBIRT ED Monthly FTE Report
Specialty Employment Provider (SEP)
- Specialty Employment Provider (SEP) Monthly Report
- Specialty Employment Provider (SEP) Supplemental Monthly Report
Zero Youth Detention
- Zero Youth Detention IFD Monthly Report

Quarterly

Clinician Roster
Contractor Profile Update
Emergency Department/Psych Emergency Services Care Manager
- ED PES Care Manager Quarterly Log
Emergency Department Utilization Management (EDUM) Behavioral Health Rapid Response Team
- A report of activities, trainings, and expenditures in a format approved by the County, if applicable
Specialty Employment Provider (SEP)
- Specialty Employment Provider (SEP) Quarterly Report
Third-Party Payment Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
Involuntary Treatment Triage
- Involuntary Treatment Triage Monthly Report
SBIRT Emergency Department Services
- Provide specific information for the MIDD Annual Report as requested by the County
Supported Employment Program
- Provide specific information for the MIDD Annual Report as requested by the County

The Healing Lodge of the Seven Nations

Invoice Form(s)

The Healing Lodge of the Seven Nations Invoice Form

Required Reports & Timeframes

Monthly

SUD Residential Census Report - Youth Intensive Inpatient

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Health Point

Invoice Form(s)

Health Point Invoice Form

Required Reports & Timeframes

Monthly

COVID FQHC Report

Hepatitis Education Project

Invoice Form(s)

Hepatitis Education Project Invoice Form

Hero House

Invoice Form(s)

Hero House Northwest Invoice Forms

Required Reports & Timeframes

Monthly

Clubhouse Census Report
Consumer-Driven Services Census Log
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
Monthly progress note to Outpatient Benefit holder for each enrolled consumer served
Specialty Employment Provider (SEP) Monthly Report
Specialty Employment Provider (SEP) Supplemental Report (as needed)

Quarterly

Annual/Other

Annual Report (upon request)
Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
SEP MIDD (upon request)

Highland Ridge Hospital

Highland Ridge Hospital Invoice Form

Holding the Hope

Holding the Hope Invoice Form

IKRON

Invoice Form(s)

IKRON Invoice Form

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
Health Home Due Diligence Tracking Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Institute for Family Development

Institute for Family Development Invoice Forms

Integrative Counseling Services

Invoice Form(s)

Integrative Counseling Services Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submissions to the BHRD Management Information System

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Intercept Associates

Invoice Form(s)

Intercept Associates Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Interchange Northwest

Invoice Form(s)

Interchange Northwest Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Ombuds Services Monthly Report
Ombuds Services Monthly Time Sheet

Quarterly

Grievances & Fair Hearings Quarterly Report
Ombuds Services Quarterly Telephone Contact Log
Quarterly Update Package
Third-Party Payment Report

Semi-Annual

Ombuds Service Semi-Annual Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

International Community Health Services

Invoice Form(s)

International Community Health Services Invoice Form

Required Reports & Timeframes

Monthly

COVID FQHC Report

Kelley-Ross Pharmacy

Kelley-Ross Pharmacy Invoice Forms

Kent Youth & Family Services

Invoice Form(s)

Kent Youth & Family Services Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Youth Diversion Services Tracking Report
Youth Support Services FTE Report

Quarterly

Contractor Profile Update

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

King County Sexual Assault Resource Center

Invoice Form(s)

King County Sexual Assault Resource Center Invoice Form

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
SA-BH Services Monthly Summary Report
SA-BH Services MIDD Evaluation Data Report

Quarterly

Contractor Profile Update

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
SA-BH Services Annual Outcomes Report

Lake Whatcom Residential and Treatment

Lake Whatcom Residential and Treatment Invoice Forms

LifeWire

Invoice Form(s)

LifeWire Invoice Form

Required Reports & Timeframes

Monthly

DV-BH Services Monthly Staffing Report
DV-BH Services Monthly Summary Report
DV-BH Services MIDD Evaluation Data Report

Quarterly

Contractor Profile Update

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
DV-BH Services Annual Outcomes Report

Lutheran Community Services Northwest

Invoice Form(s)

Lutheran Community Services NW Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report

Metropolitan Development Council

Invoice Form(s)

Metropolitan Development Council Invoice Form

Required Reports & Timeframes

Monthly

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)

Muckleshoot Indian Tribe

Invoice Form(s)

Muckleshoot Indian Tribe Invoice Forms

Required Reports & Timeframes

Monthly

Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System

Quarterly

Contractor Profile Quarterly Update
Mental Health for Children, Adults, Older Adults, and Families
Tribal Substance Use Disorder Treatment Services

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Multicare Behavioral Health

Invoice Form(s)

Multicare Behavioral Health Invoice Form

Required Reports & Timeframes

Monthly

COVID Relief Fund Report

National Alliance on Mental Illness (NAMI) Eastside

Invoice Form(s)

NAMI Eastside Invoice Form

Required Reports & Timeframes

Monthly

National Alliance on Mental Illness (NAMI) Seattle

Invoice Form(s)

NAMI Seattle Invoice Form

Required Reports & Timeframes

Monthly

KC Consumer Training Fund Monthly Expenditures

Quarterly

Contractor Profile Update

Semi-Annual

KC Consumer Training Fund Semi-Annual Status Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
Closure Dates Report
KC Consumer Training Fund Conference & Seminar Approval List Annual Report

National Alliance on Mental Illness (NAMI) South King County

Invoice Form(s)

NAMI South King County Invoice Form

Required Reports & Timeframes

Monthly

Navos

Invoice Form(s)

Navos Invoice Forms

Required Reports & Timeframes

Monthly

COVID Fund Relief Form
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
HARPS Housing Bridge Subsidy
ICSRP Monthly Census Log
ICSRP Monthly Engagement Log
LTR Billing Report
PACT Monthly Report
Peer Bridger Monthly Staffing Report
Peer Bridger Monthly Voucher Report
Residential Invoice Report
SEP Supplemental
SSH Report

Quarterly

Semi-Annual

PACT Transition Assessment Scale

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

Neighborcare Health Center

Invoice Form(s)

Neighborcare Health Center Invoice Form

Required Reports & Timeframes

Monthly

COVID FQHC Report

Neighborhood House

Invoice Form(s)

Neighborhood House Invoice Form

Required Reports & Timeframes

Monthly

NEH PEACE Monthly Actual Expenditure Report Form
Minerva Monthly Report

Quarterly

Minerva Monthly Report

New Beginnings

Invoice Form(s)

New Beginnings Invoice Form

Required Reports & Timeframes

Monthly

DV-BH Services Monthly Staffing Report
DV-BH Services Monthly Summary Report
DV-BH Services MIDD Evaluation Data Report

Quarterly

Contractor Profile Update

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan
DV-BH Services Annual Outcomes Report

New Horizon Care Centers

Invoice Form(s)

New Horizon Care Centers Invoice Forms

Required Reports & Timeframes

Monthly

SUD Residential Census Report

Quarterly

Contractor Profile Quarterly Update

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Disaster Recovery Business Continuity Attestation
Disaster Recovery Business Continuity Plan

New Traditions

Invoice Form(s)

New Traditions Invoices Form

Required Reports & Timeframes

Monthly

Monthly Pregnant & Parenting Women (PPW) & Child Care Report
COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

Northshore Youth & Family Services

Northshore Youth & Family Services Invoice Form

Northwest Ambulance

Invoice Form(s)

Northwest Ambulance Invoice Form

Required Reports & Timeframes

Monthly

Court Times Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report

Olalla Recovery Centers

Invoice Form(s)

Olalla Recovery Centers Invoice Form

Required Reports & Timeframes

Monthly

SUD Residential Census Report - Adult Intensive Inpatient

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Disaster Recovery Business Continuity Plan Update

Oxford House

Invoice Form(s)

Oxford House Invoice Form

Required Reports & Timeframes

Monthly

Rapid Re-Housing FTE Report
Rapid Re-Housing Monthly Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)

Peer Seattle (formerly Seattle Area Support Groups)

Peer Seattle (formerly Seattle Area Support Groups) Invoice Form

Peer Washington

Peer Washington Invoice Form

Pioneer Human Services

Invoice Form(s)

Pioneer Human Services Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Diversion and Reentry Services Care Coordination
HARPS Housing Bridge Subsidy
HARPS Participant Log
Housing Services for King County Regional Mental Health Court
PACT Monthly Report
PACT Transition Assessment Scale
SUD Assessments - Therapeutic Courts & Jail Health Release Planning
SUD Residential Census Report
Sobering Adult CM CDI Report
TRP Monthly Data Log

Quarterly

Semi-Annual

PACT Transition Scale

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

Public Defender Association

Public Defender Association Invoice Forms

Puget Sound Education Service District

Invoice Form(s)

Puget Sound Education Service District Invoice Forms

Required Reports &Timeframes

Monthly

CDFY Monthly Actual Expenditure Report Form
SB SBIRT CPWI Pilot Project Monthly Report
Minerva Monthly Report

Quarterly

Minerva Quarterly Report

Recovery Cafe

Invoice Form(s)

Recovery Cafe Invoice Forms

Required Reports & Timeframes

Monthly

New Recovery Cafe Development Costs
SOR Recovery Support Services Opiate Use Disorder Billing Summary
SOR Recovery Support Services Substance Use Disorder Billing Summary
Substance Use Disorder Peer Recovery Services Monthly FTE Report
WASEC Recovery Supports Systems Program Monthly Report

Quarterly

Contractor Profile Quarterly Update

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

Recovery Innovations

Invoice Form(s)

Recovery Innovations Invoice Forms

Required Reports & Timeframes

Monthly

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)

Refugee Women's Alliance

Invoice Form(s)

Refugee Women's Alliance Invoice Form

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
DV-BH Services Monthly Staffing Report
DV-BH Services Monthly Summary Report
DV-BH Services MIDD Evaluation Data Report
Monthly Interpreter Detail

Quarterly

Contractor Profile Update

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report
DV-BH Services Annual Outcomes Report

Residence XII

Residence XII Invoice Form

Ryther Center

Invoice Form(s)

Ryther Center Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
Health Homes
- Health Homes Due Diligence Report
- Juvenile Justice Assessment Team (JJAT)
Medication-Assisted Treatment (MAT)
- Co-pay Deductible Report (as funding is available)
- MAT Out-of County Report
New Journeys Demonstration Project
- New Journeys Demonstration Project Monthly Report
Outstation/Recovery School Youth Support Services (YSS)
- YSS FTE Report

Quarterly

Clinician Roster
Contractor Profile Quarterly Update
Health Homes
- Health Homes Quarterly Report
New Journeys Demonstration Project
- New Journeys Demonstration Project Quarterly Reconciliation Report
YSS Quarterly Report
Third Party Payment Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)
Health Homes

Saint Anne Hospital (fomerly Highline Medical Center)

Invoice Form(s)

Saint Anne Hospital Invoice Form

Required Reports & Timeframes

Annual/Other

SBIRT ED FTE Report

Saint Francis Hospital

Invoice Form(s)

Saint Francis Hospital Invoice Form

Required Reports & Timeframes

Annual/Other

SBIRT ED FTE Report

Seadrunar

Invoice Form(s)

Seadrunar Center Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
SUD Residential Census Report
Withdrawal Management with Linkages to Treatment - Census Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)

Sea Mar Community Health Centers

Invoice Form(s)

Sea Mar Community Health Centers Invoice Forms

Required Reports & Timeframes

Monthly

COVID FQHC Report
COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
SUD Residential Census Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

Seattle Children’s (Odessa Brown Children’s Clinic)

Invoice Form(s)

Seattle Children's Invoice Form

Required Reports & Timeframes

Monthly

COVID FQHC Report

Seattle Counseling Services

Invoice Form(s)

Seattle Counseling Services Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)
Participate in County's Annual Report to DBHR for HASAP

Seattle Indian Health Board

Invoice Form(s)

Seattle Indian Health Board Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submissions to the BHRD Management Information System
SUD Residential Census Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

Seattle Public Schools

Invoice Form(s)

Seattle Public Schools Invoice Forms

Required Reports & Timeframes

Monthly

Minerva Monthly Report
Seattle SBIRT Financial Report
SPS HYCAN Monthly Actual Expenditure Report Form
YSS FTE Report

Quarterly

Minerva Quarterly Report
YSS Quarterly Report

Seneca Family of Agencies

Invoice Form(s)

Seneca Family of Services Invoice Form

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

Seven Challenges

Seven Challenges 2019 Invoice Form

Snoqualmie Indian Tribe

Invoice Form(s)

Snoqualmie Indian Tribe Invoice Forms

Required Reports & Timeframes

Monthly

Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System

Quarterly

Contractor Profile Quarterly Update
Mental Health for Children, Adults, Older Adults, and Families
Tribal Substance Use Disorder Treatment Services

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report

Sound

Invoice Form(s)

Sound Invoice Forms

Required Reports & Timeframes

Monthly

Adult Crisis Services Report
Assisted Outpatient Services Program
Benson Heights Monthly Report
CDVRT Monthly Summary Report
COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
Long-Term Rehabilitation Services Billing Report Services Monthly Summary
Long-Term Rehabilitation Services Residential Invoice Report
Path Monthly Report
Reaching Recovery
- FIRST Report
- ORCS Report
- Reaching Recovery Housing Monthly Log
Specialty Employment Provider (SEP) Monthly Report
Specialty Employment Provider (SEP) Supplemental Monthly Report
South King County Housing First Monthly Move-In Report
South King County Housing First Monthly Move-Out Report
Standard Supportive Housing Monthly Report
STAR Program Monthly Status Report
SUD Outpatient Monthly Transportation Back-up (as needed)
Transition Support Program Linkage Report
Transition Support Program Monthly Staffing Report
Wraparound Contract Monthly Summary
Wraparound Flex Fund Request Form
Wraparound Flex Fund Request Interpreter Form
Wraparound Flex Fund Request Special Event Form
Wraparound Monthly Flex Fund Expenditures Report

Quarterly

Clinician Roster
Contractor Profile Quarterly Update
LTR Self-Medication Quarterly Report
PATH Quarterly Report
PATH Quarterly Report
Reaching Recovery Consumer Recovery Measure (for all program participants)
Reaching Recovery Marker Inventory (for all program participants)
Specialty Employment Provider (SEP) Quarterly Report
Third Party Payment Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

Southwest Youth & Family Services

Southwest Youth & Family Services Invoice Form

Specialty Services II

Invoice Form(s)

Specialty Services II Invoice Form

Required Reports & Timeframes

Monthly

SUD Census Report
SUD Residential Census Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

Spokane Addiction Recovery Centers

Invoice Form(s)

Spokane Addiction Recovery Centers Invoice Forms

Required Reports & Timeframes

Monthly

SUD Residential Census Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Disaster Recovery Business Continuity Plan Update(s)

Tacoma-Pierce County Health Department

Invoice Form(s)

Tacoma-Pierce County Health Department Invoice Form

Required Reports & Timeframes

Monthly

Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

Telecare

Invoice Form(s)

Telecare Invoice Form

Required Reports & Timeframes

Monthly

Quarterly

Third Party Payment Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

Therapeutic Health Services

Invoice Form(s)

Therapeutic Health Services Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
MAT Out of County Report
MST FTE Report
MST Monthly Status Report
PPW Monthly Report
SBIRT Monthly Staffing Report
YEP Monthly Status Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)
MST Annual Client Profile Report
YEP Annual Client Profile Report

Transitional Resources

Invoice Form(s)

Transitional Resources Invoice Forms

Required Reports & Timeframes

Monthly

Adult Inpatient Diversion Bed Monthly Report
COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
Long-Term Residential Monthly Billing Report Services
Long-Term Residential Monthly Residential Invoice Monthly Report

Quarterly

Clinician Roster
Contractor Profile Quarterly Update
Long Term Rehabilitation Services Self-Medication Quarterly Report
Third Party Payment Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

Triumph Treatment Services

Invoice Form(s)

Triumph Treatment Services Invoice Forms

Required Reports & Timeframes

Monthly

SUD Residential Census Report & MAT Log

Quarterly

Third Party Payment Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Disaster Recovery Business Continuity Plan Update(s)

University of Washington

University of Washington Family Integrated Transitions Invoice Forms

University of Washington Alcohol & Drug Abuse Institute

University of Washington ADAI Invoice Forms

Valley Cities Counseling & Consultation

Invoice Form(s)

Valley Cities Counseling & Consultation Invoice Forms

Required Reports & Timeframes

Monthly

Adult Crisis Services Log
COVID Relief Fund Report
Data Certification Letter
Health Home Due Diligence Tracking
Mental Health First Aid (MHFA) FTE Report
Mental Health First Aid (MHFA) Monthly Performance Report
New Journeys Demonstration Project
Specialty Employment (SEP) Monthly Report
Specialty Employment (SEP) Monthly Report - Part 1 Outcomes
Standard Supportive Housing Rental Assistance
SUD Residential Census Report
SUD Census Report - Withdrawal Management with Linkages to Treatment
Wraparound Flex Fund Request Form
Wraparound Flex Fund Request Interpreter Form
Wraparound Flex Fund Special Event Form
Wraparound Monthly Flex Fund Expenditures Report

Quarterly

Clinician Roster
Contractor Profile Quarterly Update
Low-Barrier Buprenorphine Treatment Expansion Quarterly Report
Specialty Employment Provider (SEP) Quarterly Report
Third Party Payment Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

Vashon Alliance to Reduce Substance Abuse (VARSA)

Vashon Alliance to Reduce Substance Abuse (VARSA) Invoice Form

Vashon Youth & Family Services (VYFS)

Invoice Form(s)

Vashon Youth & Family Services Invoice Form

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

Washington Asian Pacific Islander Families Against Substance Abuse (WAPIFASA)

Invoice Form(s)

WAPIFASA Invoice Forms

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
Youth Support Services FTE Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report

Washington Recovery Alliance

Washington Recovery Alliance Invoice Form

Washington State Criminal Justice Training Commission

Washington State Criminal Justice Training Commission Invoice Form

Washington State Department of Veterans Affairs

Washington State Dept of Veterans Affairs Invoice Form

WCHS

Invoice Form(s)

WCHS Invoice Form

Required Reports & Timeframes

Monthly

COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submission to the BHRD Management Information System
MAT Out of County Report

Quarterly

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)

YMCA of Seattle

Invoice Form(s)

YMCA Invoice Forms

Required Reports & Timeframes

Monthly

Children's Crisis Outreach Response System (CCORS) Monthly Summary
COVID Relief Fund Report
Data Certification Letter
Data & Encounter Submissions to the BHRD Management Information System
ISS Master Client List
TRACE Monthly Narrative
Wraparound Monthly Flex Fund Expenditure Report
Wraparound/WISe Monthly Summary & Training Report
Young Adult Outreach Response System Monthly Summary
Youth Connection Services Monthly Service/System Coordination Summary

Quarterly

CCORS Quarterly Mental Health Block Grant Costs & Revenue Summary
Clinician Roster
Contractor Profile Update
ISS Quarterly Data Summary Report
Third-Party Payment Report

Annual/Other

Audited Financial Statement
Certificate of Insurance & Endorsement
Client Success Stories (upon request)
Closure Dates Report
Disaster Recovery Business Continuity Plan Update(s)
Weekly Reports: Wraparound/WISe referral/screen requests, referrals source, enrollees, and pending list