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Budget Transfer - BOCC
Cash Transfer Request Date: Sept 23, 2022 To: Katie Smith, Accounting From: ARPA Committee Subject: ARPA funding transfer — Renew Please perform the following transfer request: Disbursing f md: 191— ARPA Local Fiscal Recovery Transfer from: 191.001.00.0000.597000000 (ARPA transfers -out) Transfer to: 180.150.00.0000.397000010 (Evenew transfer -in) Amount: $ 48,526.04 Description: Uninsured Services for January — August 19, 2022 I have authority for the disbursing fund, and I authorize the above disbursement. Approval Name: DW F, s4," e. Approval Signature: L� Date: � �� AM040 reneuy GrQnt BehaviorQl HeQtt;h 6 Wellne�ss PO Box 1057 Moses Lake, WA 98837 Phone (509) 765-9239 BILL TO: Grant County Attention: Janice PO Box 37 Ephrata, WA 98823 DATE: August 31, 2022 THANK YOU FOR YOUR BUSINESS! ABPA UN INSURED Service ID Service Date Service Type CPT CPT Code Modifier Program Location Recipient Employee Name Client ID Adjusted Amount 431646 3/18/2022 CM H2O15 MH ML Clnt Home Client Edmondson, Janiel 12530153 $ 216.00 429710 3/4/2022 PeerSupSvc H0046 MH ML Clnt Home Client Edmondson, Janiel 12530153 $ 36.00 429702 3/9/2022 PeerSupSvc H0038 MH ML OthrCommSet Client Edmondson, Janiel 12530153 $ 72.00 435348 3/29/2022 PeerSupSvc H0038 MH ML OthrCommSet Client Edmondson, Janiel 12530153 $ 90.00 408562 1/5/2022 PostHospFU T1016 ET Crisis ML OthrCommSet Client Garcia, Jesus 12530161 $ 75.00 406883 1/3/2022 Rehab CM H0023 MH ML Office Oth Agency Fulkerson, Shannon 12530161 $ 37.50 408360 1/6/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12531684 $ 320.00 409492 1/10/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12531684.$ 40.00 409680 1/11/2022 CM H2O15 MH MT Office Fam+Client Roman -Estrada, Magalie (Maggie) 12531684 $ 160.00 414411 1/26/2022 CM H2O15 MH MT Clnt Home Phone Roman -Estrada, Magalie (Maggie) 12531684 $ 80.00 414813 1/27/2022 CM H2O15 MH MT Office Fam+Client Roman -Estrada, Magalie (Maggie) 12531684 $ 80.00 416473 2/2/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12531684 $ 120.00 419218 2/10/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12531684 $ 200.00 425596 3/2/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12531684 $ 160.00 426907 3/7/2022 CM H2O15 MH MT Clnt Home Fam+Client Roman -Estrada, Magalie (Maggie) 12531684 $ 160.00 432635 3/23/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12531684.$ 120.00 441671 4/18/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12531684 $ 40.00 452704 5/19/2022 CM H0046 MH EP Office Phone Roman -Estrada, Magalie (Maggie) 12531684 $ 40.00 457146 6/1/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12531684 $ 80.00 458513 6/6/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12531684 $ 120.00 461203 6/13/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12531684 $ 80.00 461880 6/14/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12531684 $ 80.00 462362 6/16/2022 CM H2O15 MH MT Clnt Home Fam+Client Roman -Estrada, Magalie (Maggie) 12531684 $ 280.00 465459 6/23/2022 CM H2O15 MH MT Cint Home Fam+Client Roman -Estrada, Magalie (Maggie) 12531684 $ 240.00 467337 6/30/2022 CM H2O15 IMH QU Office Phone Roman -Estrada, Magalie (Maggie) 12531684 $ 80.00 473618 7/19/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12531684.$ 80.00 414413 1/26/2022 LRASupervn H2O15 MH MT Office Clt Not Pr Roman -Estrada, Magalie (Maggie) 12531684 $ 60.00 422755 2/22/2022 LRASupervn H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12531684 $ 60.00 430926 3/16/2022 CM H2O15 MH ML Office Client Carlson, Jessica 12531935 $ - 419245 2/10/2022 Intake H0031 MH ML Office Fam+Client Shoemake, Carol 12531935 $ 225.00 413600 1/24/2022 Individual 90837 MH QU Office Client Guerrero, Conne 12532103 $ 240.00 412994 1/21/2022 CM H2O15 MH QU Cint Home Phone Gonzalez, Madison 12532335 $ 40.00 422189 2/18/2022 CM H2O15 MH QU Office Client Gonzalez, Madison 12532335 $ 80.00 433653 3/25/2022 CM H2O15 MH QU Clnt Home Phone Gonzalez, Madison 12532335 $ 80.00 443906 4/25/2022 CM H2O15 MH QU Clnt Home Phone Gonzalez, Madison 12532335 $ 40.00 454746 5/24/2022 Individual 90837 MH ML Office Client Nunez, Tanya 12532601 $ 240.00 459222 6/7/2022 Individual 90837 MH ML Office Client Nunez, Tanya 12532601 $ 240.00 466814 6/28/2022 Individual 90837 MH ML Office Client Nunez, Tanya 12532601 $ 240.00 472299 7/14/20221 Individual 1 90834 1 MH ML Office Client Nunez, Tanya 12532601 $ 180.00 $ 414.00 $ 112.50 $ 2,680.00 $ 705.00 Service ID Service Date Service Type CPT CPT Code Modifier Program Location Recipient Employee Name Client ID Adjusted Amount 480282 8/5/2022 Individual 90834 MH ML Office Client Nunez, Tanya 12532601 $ 180.00 450323 5/12/2022 Intake H0031 MH ML Office Client Wilkinson, Barbara (Barb) 12532601 $ 250.00 407240 1/3/2022 CM H2O15 MH EP Cint Home Phone Griffith, Brianne 12533176 $ 40.00 412252 1/18/2022 CM H2O15 MH EP Clnt Home Phone Griffith, Brianne 12533176 $ 80.00 418938 2/8/2022 CM H2O15 MH EP Clnt Home Client Griffith, Brianne 12533176 $ 80.00 419785 2/10/2022 CM H2O15 MH EP Clnt Home Phone Griffith, Brianne 12533176 $ 40.00 421557 2/16/2022 CM H2O15 MH EP Clnt Home Phone Griffith, Brianne 12533176 $ 120.00 422767 2/22/2022 CM H2O15 MH EP Clnt Home Fam+Client Griffith, Brianne 12533176 $ 200.00 437632 4/5/2022 CM H2O15 MH EP Clnt Home Client Griffith, Brianne 12533176 $ 80.00 445420 4/27/2022 CM H2O15 MH EP Clnt Home Fam+Client Griffith, Brianne 12533176 $ 80.00 448241 5/5/2022 CM H2O15 MH EP Clnt Home Phone Griffith, Brianne 12533176 $ 40.00 449045 5/6/2022 CM H2O15 MH EP Clnt Home Client Griffith, Brianne 12533176 $ 80.00 451343 5/12/2022 CM H2O15 MH EP Clnt Home Phone Griffith, Brianne 12533176 $ 80.00 453508 5/19/2022 CM H2O15 MH EP Clnt Home Phone Griffith, Brianne 12533176 $ 40.00 466592 6/28/2022 CM H2O15 MH EP Clnt Home Client Griffith, Brianne 12533176 $ 80.00 482029 8/10/2022 CM H2O15 MH EP Clnt Home Phone Griffith, Brianne 12533176 $ 40.00 431582 3/21/2022 Intake H0031 MH ML Office Client Shoemake, Carol 12533583 $ 250.00 427894 3/9/2022 CM H2O15 MH ML Office Client Martinez, Elizabeth 12535495 $ 160.00 430098 3/16/2022 CM H2O15 MH ML Office Client Martinez, Elizabeth 12535495 $ 120.00 436844 4/4/2022 CM H2O15 MH ML Office Fam+Client Martinez, Elizabeth 12535495 $ 80.00 424814 3/1/2022 Intake H0031 MH ML Office Fam+Client Shoemake, Carol 12535495 $ 250.00 463988 6/21/2022 Individual 90837 MH EP Office Client Hernandez, Karen 12535834 $ 240.00 467319 6/29/2022 Individual 90837 MH EP Office Client Hernandez, Karen 12535834 $ 240.00 469294 7/6/2022 Individual 90837 MH EP Office Client Hernandez, Karen 12535834 $ 240.00 471814 7/13/2022 Individual 90834 MH EP Office Phone Hernandez, Karen 12535834 $ 180.00 474346 7/21/2022 Individual 90837 MH EP Office Client Hernandez, Karen 12535834 $ 240.00 478731 8/3/2022 Individual 90837 MH EP Office Client Hernandez, Karen 12535834 $ 240.00 481005 8/10/2022 Individual 90837 MH EP Office Client Hernandez, Karen 12535834 $ 240.00 459765 6/7/2022 Intake 90791 MH EP School Client Garza, Irene 12535834 $ 250.00 439097 4/11/2022 Individual 90837 MH EP Office Client Pinckard, Devin 12537224 $ 240.00 444118 4/25/2022 Individual 90837 MH EP Office Client Pinckard, Devin 12537224 $ 240.00 453976 5/23/2022 Individual 90837 MH EP Office Client Pinckard, Devin 12537224 $ 240.00 457859 6/2/2022 Individual 90837 MH EP Office Client Pinckard, Devin 12537224 $ 240.00 459374 6/7/2022 Individual 90837 MH EP Office Client Pinckard, Devin 12537224 $ 240.00 478258 8/2/2022 Individual 90834 MH EP Clnt Home Phone Pinckard, Devin 12537224 $ 180.00 482378 8/15/2022 Individual 90834 MH EP Office Phone Pinckard, Devin 12537224 $ 180.00 432538 3/23/2022 Intake H0031 MH EP Clnt Home Client Wilkinson, Barbara (Barb) 12537224 $ 250.00 418898 2/9/2022 Individual 90837 MH RC School Client Gonzalez, Madison 12537724 $ 240.00 421062 2/16/2022 Pridividual 90837 MH RC School Client Gonzalez, Madison 12537724 $ 240.00 424382 2/28/2022 1 Individual 90837 MH RC School Client Gonzalez, Madison 12537724 $ 240.00 $ 1,330.00 $ 1,080.00 $ 250.00 $ 610.00 $ 1,870.00 Service ID Service Date Service Type CPT CPT Code Modifier Program Location Recipient Employee Name Client ID Adjusted Amount 417256 2/4/2022 Intake H0031 GT MH RC Telehealth Phone Shoemake, Carol 12537724 $ 250.00 428500 3/9/2022 Individual 90837 MH RC School Client Escamilla, Reina 12537741.$ 240.00 445998 4/27/2022 Individual 90832 MH RC School Client Escamilla, Reina 12537741 $ 120.00 483519 8/18/2022 Individual 90837 MH RC Office Client Guerrero, Conne 12537770 $ 240.00 460950 6/13/2022 Intake H0031 MH ML Office Client Wilkinson, Barbara (Barb) 12537770 $ 250.00 443750 4/20/2022 CM H2O15 MH ML Clnt Home Client Martinez, Elizabeth 12537953 $ - 453654 5/23/2022 CM H2O15 MH ML Clnt Home Phone Martinez, Elizabeth 12537953 $ - 437855 4/6/2022 Intake H0031 MH ML Office Phone Wilkinson, Barbara (Barb) 12537953 $ - 442549 4/20/2022 Individual 90834 MH QU School Client Guerrero, Conne 12538350 $ 180.00 448367 5/6/2022 Individual 90837 MH QU School Client Guerrero, Conne 12538350 $ 240.00 453970 5/23/2022 Individual H0046 MH QU School Client Guerrero, Conne 12538350 $ 60.00 433678 3/25/2022 Intake 90791 MH QU School Client Guerrero, Conne 12538350 $ 250.00 472326 7/15/2022 Intake H0031 MH ML Office Client Shoemake, Carol 12539758 $ 250.00 426811 3/2/2022 Individual 90837 MH RC School Client Escamilla, Reina 12540113 $ 240.00 433671 3/23/2022 Individual 90837 MH RC School Client Escamilla, Reina 12540113 $ 240.00 440390 4/13/2022 Individual 90837 MH IMH RC School Client Escamilla, Reina 12540113 $ 240.00 450378 5/11/2022 Individual 90834 RC School Client Escamilla, Reina 12540113 $ 180.00 457777 6/1/2022 Individual 90832 MH RC School Client Escamilla, Reina 12540113 $ 120.00 460635 6/8/2022 Individual 90834 MH RC School Client Escamilla, Reina 12540113 $ 180.00 417328 2/4/2022 Intake H0031 GT MH RC Telehealth Phone Shoemake, Carol 12540113 $ 250.00 408363 1/5/2022 CM H2015 MH ML Office Client Hardy, Ryan 12540194 $ 80.00 428997 3/10/2022 CM H2015 MH ML Office Client Hardy, Ryan 12540194 $ 40.00 468946 7/6/2022 Individual 90837 MH RC Office Client Gonzalez, Madison 12540502 $ 240.00 473671 7/20/2022 Individual 90837 MH RC Office Client Gonzalez, Madison 12540502 $ 240.00 476172 7/27/2022 Individual 90837 MH RC Office Client Gonzalez, Madison 12540502 $ 240.00 480768 8/10/2022 Individual 90834 MH RC Office Client Gonzalez, Madison 12540502 $ 180.00 464930 6/23/2022 Intake H0031 MH RC Telehealth Phone Shoemake, Carol 12540502 $ 250.00 422809 2/22/2022 Intake H0031 MH EP Office Client Wilkinson, Barbara (Barb) 12540512 $ 180.00 422220 2/18/2022 Individual 90837 MH ML Office Client Nunez, Tanya 12540729 $ 240.00 426491 3/4/2022 Individual 90837 MH ML Office Client Nunez, Tanya 12540729 $ 240.00 431399 3/18/2022 Individual 90837 MH ML Office Client Nunez, Tanya 12540729 $ 240.00 436476 4/1/2022 Individual 90834 MH ML Office Client Nunez, Tanya 12540729 $ 180.00 448224 5/6/2022 Individual 90837 MH ML Office Client Nunez, Tanya 12540729 $ 240.00 460563 6/10/2022 Individual 90837 MH ML Office Client Nunez, Tanya 12540729 $ 240.00 465124 6/24/2022 Individual 90834 MH ML Office Client Nunez, Tanya 12540729 $ 180.00 483869 8/19/2022 Individual 90837 MH ML Office Client Nunez, Tanya 12540729 $ 240.00 413020 1/21/2022 Intake H0031 MH ML Office Client Shoemake, Carol 12540729 $ 250.00 426321 3/3/2022 Individual 90834 MH EP Office Client Guerrero, Conne 12541233 $ 180.00 412170 1/18/2022 CM H2O15 MH ML Office Client Hardy, Ryan 12541302 $ 80.00 420767 2/14/2022 CM H2015 MH ML Office Client H a rdy, Ryan 12541302 $ 160.00 $ 2,780.00 $ 360.00 $ 490.00 730.00 250.00 $ 1,450.00 $ 120.00 1,150.00 180.00 2,050.00 180.00 $ 240.00 Service ID Service Date Service Type CPT CPT Code Modifier Program Location Recipient Employee Name Client ID Adjusted Amount 416171 2/1/2022 CM H2O15 MH MT Clnt Home Phone Roman -Estrada, Magalie (Maggie) 12541314 $ 40.00 424281 2/24/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12541314 $ 80.00 428116 3/9/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12541314 $ 80.00 435355 3/30/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12541314 $ 80.00 440421 4/14/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12541314 $ 80.00 442670 4/20/2022 CM H2O15 MH MT School 0th Agency Roman -Estrada, Magalie (Maggie) 12541314 $ 40.00 458799 6/7/2022 Discharge 90832 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541314 $ 120.00 414208 1/26/2022 Individual 90837 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541314 $ 240.00 418905 2/9/2022 Individual 90834 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541314 $ 180.00 430296 3/16/2022 Individual 90832 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541314 $ 120.00 442455 4/20/2022 Individual 90837 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541314 $ 240.00 450004 5/11/2022 Individual 90837 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541314 $ 240.00 411975 1/18/2022 CM H2O15 MH RC Office Parent Valdez, Sonia 12541381 $ 80.00 424580 2/25/2022 CM H2O15 MH RC Office Client Valdez, Sonia 12541381 $ 160.00 427736 3/8/2022 CM H2O15 MH RC Office Client Valdez, Sonia 12541381 $ 120.00 432038 3/21/2022 CM H2O15 MH RC Office Client Valdez, Sonia 12541381 $ 120.00 449976 5/11/2022 Intake 90791 MH ML Clnt Home Phone Miller, Judy 12541487 $ - 411090 1/13/2022 CM H2O15 MH MT School Client Valdez, Sonia 12541550 $ 160.00 426580 3/3/2022 CM H2O15 MH MT School Client Valdez, Sonia 12541550 $ 80.00 446035 4/28/2022 CM H0046 MH MT School Oth Agency Valdez, Sonia 12541550 $ 40.00 448301 5/5/2022 CM H2O15 MH MT School Client Valdez, Sonia 12541550 $ 120.00 453274 5/18/2022 CM H2O15 MH MT School Client Valdez, Sonia 12541550 $ 120.00 458608 6/3/2022 CM H2O15 MH MT School Client Valdez, Sonia 12541550 $ 80.00 407021 1/3/2022 Intake H0031 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541550 $ 250.00 424213 2/25/2022 CM H2O15 MH GC Clnt Home Phone Griffith, Brianne 12541631 $ 160.00 439678 4/11/2022 CM H2O15 MH GC Office Client Griffith, Brianne 12541631 $ 160.00 446810 5/2/2022 CM H2O15 MH GC Office Client Griffith, Brianne 12541631 $ 200.00 452039 5/16/2022 CM H2O15 MH GC Office Client Griffith, Brianne 12541631 $ 200.00 456689 5/31/2022 CM H2O15 MH GC Office Client Griffith, Brianne 12541631 $ 160.00 467822 7/1/2022 CM H2O15 MH GC Office Client Garza, Irene 12541631 $ 120.00 480321 8/8/2022 CM H2O15 MH GC Office Client Griffith, Brianne 12541631 $ 160.00 430373 3/15/2022 Individual 90834 MH ML Office Client Crawford, Matt 12541847 $ 180.00 435634 3/30/2022 Individual 90834 MH ML Office Client Crawford, Matt 12541847 $ 180.00 442258 4/19/2022 Individual 90834 MH ML Office Client Crawford, Matt 12541847 $ 180.00 423853 2/24/2022 Intake H0031 MH ML Office Client Wilkinson, Barbara (Barb) 12541847 $ 250.00 434250 3/28/2022 CM H0046 MH QU Clnt Home 0th Agency Guerrero, Conne 12541856 $ 40.00 433685 3/25/2022 Intake 90791 MH QU School Client Guerrero, Conne 12541856 $ 250.00 444996L623 022 CM H2O15 MH ML Office Client Antonio, Paula 12541857 $ 112.00 454117022 CM H2O15 MH ML Office Client Escamilla, Bethany 12541857 $ 84.00 464414022 CM H2O15 MH I ML Office Client Escamilla, Bethany 12541857 $ 84.00 $ 11540.00 $ 480.00 $ 850.00 $ 1,160.00 $ 790.00 $ 290.00 Service ID Service Date Service Type CPT CPT Code Modifier Program Location Recipient Employee Name Client ID Adjusted Amount 477063 7/29/2022 CM H2O15 MH ML OthrCommSet Phone Escamilla, Bethany 12541857 $ 28.00 483227 8/18/2022 CM H2O15 MH ML Office Client Escamilla, Bethany 12541857 $ 56.00 436296 4/1/2022 Intake H0031 MH ML Office Client Shoemake, Carol 12541857 $ 175.00 444047 4/25/2022 Individual 90837 MH ML Office Client Padilla, Juan 12541929 $ 240.00 450628 5/12/2022 Individual 90834 MH ML Office Client Padilla, Juan 12541929 $ 180.00 463763 6/21/2022 Individual 90834 MH ML Office Client Padilla, Juan 12541929 $ 180.00 474422 7/21/2022 Individual 90834 MH ML Office Client Padilla, Juan 12541929 $ 180.00 438722 4/8/2022 Intake H0031 MH ML Office Client Shoemake, Carol 12541929 $ 250.00 428114 3/9/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12541967 $ 120.00 441458 4/18/2022 Discharge 90832 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12541967 $ 120.00 431450 3/17/2022 Individual 90832 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541967 $ 120.00 426925 3/7/2022 Intake H0031 MH MT Office Fam+Client Roman -Estrada, Magalie (Maggie) 12541967 $ 250.00 427108 3/7/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12541983 $ 160.00 427954 3/9/2022 CM H2O15 MH MT School Oth Agency Roman -Estrada, Magalie (Maggie) 12541983 $ 120.00 428322 3/10/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12541983.$ 40.00 429357 3/14/2022 CM H2O15 MH MT Office Oth Agency Roman -Estrada, Magalie (Maggie) 12541983 $ 40.00 440424 4/14/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12541983 $ 80.00 441270 4/18/2022 CM H2O15 MH MT Office Oth Agency Roman -Estrada, Magalie (Maggie) 12541983 $ 40.00 451176 5/16/2022 CM H2O15 MH MT Office Oth Agency Roman -Estrada, Magalie (Maggie) 12541983 $ 80.00 458516 6/6/2022 CM H2O15 MH MT Office Phone Roman -Estrada, Magalie (Maggie) 12541983 $ 40.00 461528 6/14/2022 Discharge 90834 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541983 $ 180.00 430249 3/16/2022 Individual 90837 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541983 $ 240.00 434683 3/29/2022 Individual 90832 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541983 $ 120.00 442438 4/20/2022 Individual 90834 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541983 $ 180.00 449923 5/11/2022 Individual 90834 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541983 $ 180.00 426846 3/7/2022 Intake H0031 MH MT School Client Roman -Estrada, Magalie (Maggie) 12541983 $ 250.00 432061 3/22/2022 Intake H0031 MH EP Office Client Wilkinson, Barbara (Barb) 12542006 $ 250.00 433931 3/28/2022 CM H2O15 MH GC Office Client Heen, Michelle 12542039 $ - 436651 4/4/2022 CM H2O15 MH GC Office Client Heen, Michelle 12542039 $ - 444125 4/25/2022 CM H2O15 MH GC Office Client Heen, Michelle 12542039 $ - 431797 3/21/2022 Intake 90791 MH GC Clnt Home Phone Miller, Judy 12542039 $ - 433658 3/25/2022 Intake H0031 MH ML Clnt Home Client Wilkinson, Barbara (Barb) 12542049 $ 250.00 435522 3/30/2022 Individual 90834 MH ML Office Fam+Client Barnes, LaVyonne 12542068 $ 180.00 440917 4/13/2022 Individual 90837 MH ML Office Fam+Client Barnes, LaVyonne 12542068 $ 240.00 447501 4/29/2022 Individual 90834 MH ML Office Client Barnes, LaVyonne 12542068 $ 180.00 450120 5/11/2022 Individual 90834 MH ML Office Client Barnes, LaVyonne 12542068 $ 180.00 455954 5/25/2022 Individual 90834 MH ML Office Fam+Client Barnes, LaVyonne 12542068 $ 180.00 459784 6/8/2022 Individual 90837 MH ML Office Fam+Client Barnes, LaVyonne 12542068 $ 240.00 465398 6/23/2022 Individual 90837 MH ML Office Fam+Client Barnes, LaVyonne 12542068 $ 240.00 432776 3/23/202211 nta ke H0031 MH ML Office Client Wilkinson, Barbara (Barb) 12542068 $ 250.00 $ 539.00 $ 1,030.00 $ 610.00 $ 1,750.00 $ 250.00 $ 250.00 $ 1,690.00 Service ID Service Date Service Type CPT CPT Code Modifier Program Location Recipient Employee Name Client ID Adjusted Amount 447237 5/4/2022 CM H2O15 MH ML Office Client Fulkerson, Shannon 12542087 $ 36.00 434708 3/29/2022 Intake H0031 MH ML Office Client Shoemake, Carol 12542087.$ 225.00 443053 4/20/2022 CM H2O15 MH EP Office Client Griffith, Brianne 12542091 $ 160.00 444792 4/26/2022 CM H2O15 MH EP Office Client Griffith, Brianne 12542091 $ 160.00 449582 5/9/2022 CM H2O15 MH GC Cint Home Phone Griffith, Brianne 12542091 $ 120.00 437496 4/5/2022 Intake H0031 MH EP Office Client Wilkinson, Barbara (Barb) 12542091 $ 250.00 438927 4/11/2022 CM H2O15 MH ML Office Client Martinez, Elizabeth 12542137 $ - 443727 4/20/2022 CM H2O15 MH ML Office Client Martinez, Elizabeth 12542137 $ - 447047 5/3/2022 CM H2O15 MH ML Office Client Martinez, Elizabeth 12542137 $ 12.00 437036 4/4/2022 Intake H0031 MH ML Cint Home Phone Wilkinson, Barbara (Barb) 12542137 $ - 452408 5/18/2022 Intake H0031 MH ML Office Client Wilkinson, Barbara (Barb) 12542358 $ 225.00 455685 5/27/2022 CM H2O15 MH ML Cint Home Phone Antonio, Paula 12542384 $ 128.00 461785 6/14/2022 CM H2O15 MH ML Office Client Antonio, Paula 12542384 $ 128.00 453149 5/20/2022 Intake H0031 MH ML Office Client Wilkinson, Barbara (Barb) 12542384 $ 200.00 466491 6/28/2022 CM H2O15 MH ML Cint Home Phone Antonio, Paula 12542445 $ 120.00 480408 8/8/2022 CM H2O15 MH ML Office Client Antonio, Paula 12542445 $ 80.00 483390 8/17/2022 CM H2O15 MH ML Office Client Antonio, Paula 12542445 $ 160.00 455556 5/26/2022 Intake H0031 MH ML Office Fa m+CI ie nt Shoemake, Carol 12542445 $ 250.00 466794 6/29/2022 Individual 90832 MH EP Clnt Home Client Westermann, Cathy 12542469 $ 120.00 468479 7/5/2022 Individual 90834 MH EP Office Client Westermann, Cathy 12542469 $ 180.00 470300 7/11/2022 Individual 90837 MH EP Office Client Westermann, Cathy 12542469 $ 240.00 472630 7/18/2022 Individual 90837 MH EP Office Client Westermann, Cathy 12542469 $ 240.00 456851 6/1/2022 Intake H0031 MH EP Office Client Shoemake, Carol 12542469 $ 250.00 469293 7/6/2022 CM H2O15 MH ML Office Client Bailey, Kim 12542494 $ 160.00 471506 7/13/2022 Individual 90837 MH GC Office Client Baccellia-Ziegler, Virginia 12542540 $ 240.00 476170 7/27/2022 Individual 90837 MH GC Office Client Baccellia-Ziegler, Virginia 12542540 $ 240.00 460085 6/9/2022 Intake H0031 MH ML Cint Home Phone Hunt, Traci 12542540 $ 250.00 461125 6/13/2022 Intake H0031 MH ML Office Client Wilkinson, Barbara (Barb) 12542545 $ 250.00 473699 7/20/2022 Intake 90791 MH QU Office Client Guerrero, Conne 12542595 $ 250.00 477007 7/28/2022 Individual 90837 MH QU Office Client Guerrero, Conne 12542599 $ 240.00 480051 8/8/2022 Individual 90837 MH QU Office Client Guerrero, Conne 12542599 $ 240.00 466657 6/29/2022 Intake 90791 MH QU Office Client Guerrero, Conne 12542599 $ 250.00 479056 8/4/2022 CM H2015 MH ML Office Client Antonio, Paula 12542746 $ 160.00 478547 8/3/2022 Intake 90791 MH ML Cint Home Phone Miller, Judy 12542793 $ 250.00 482015 8/15/2022 Intake H0031 MH ML Office Client Wilkinson, Barbara (Barb) 12542845 $ 250.00 483516 8/18/2022 Intake H0031 MH ML Office Client Shoemake, Carol 12542868 $ 200.00 483413 8/18/2022 Intake 90791 MH ML Cint Home Phone Miller, Judy 12542870 $ 250.00 483786 8/19/2022 Intake H0031 MH ML Office Client Wilkinson, Barbara (Barb) 12542886 $ 250.00 TOTAL AMOUNT $ 261.00 $ 690.00 $ 12.00 $ 225.00 $ 456.00 $ 610.00 $ 1,030.00 $ 160.00 $ 730.00 $ 250.00 $ 250.00 $ 730.00 $ 160.00 $ 250.00 $ 250.00 $ 200.00 $ 250.00 $ 250.00 37,024.50 Clients Served 58 Service Provided 37024:5 Service CPT Adjusted Service ID Date Service Type CPT Code Modifier Program Location Recipient Employee Name Client ID Amount Clients Served 58 Service Provided 37024:5 Id Age Total Client Due Past Due Days 12530055 58 $ 665.00 882 12530400 53 $ 120.00 204 12531041 41 $ 375.00 91 12532408 13 $ 790.00 273 12533027 20 $ 50.00 334 12533549 17 $ 101.25 303 12537194 15 $ 45.03 235 12537953 67 $ 1,620.00 364 12538492 42 $ 522.98 729 12538926 35 $ 140.00 204 12539177 52 $ 960.00 303 12539431 42 $ 75.00 235 12539718 35 $ 277.08 235 12539975 47 $ 247.39 364 12540021 10 $ 9.40 389 12540070 21 $ 240.00 113 12540103 21 $ 41.92 91 12540199 49 $ 60.00 364 12540309 39 $ 60.00 113 12540568 14 $ 300.40 426 12540715 64 $ 148.00 364 12541015 20 $ 685.00 273 12541320 57 $ 879.44 235 12541358 27 $ 161.92 273 12541384 16 $ 250.00 54 12541599 14 $ 171.74 144 12541633 33 $ 25.00 175 12541683 7 $ 15.00 144 12541691 50 $ 30.00 175 12541799 32 $ 1,320.00 113 12541820 28 $ 70.00 144 12541916 28 $ 126.92 113 12541968 13 $ 69.07 91 12542039 13 $ 570.00 144 12542087 60 $ 29.00 144 12542298 69 $ 250.00 91 $ 11,501.54 Inactive Client Balances Dollars Client sum 36 $ 11,501.54 Client Count- ser. 36