HomeMy WebLinkAboutInvoices - Sheriff & JailEXPENSE REIMBURSEMENT CLAIM
COUNTY AUDITOR
GRANT COUNTY, WASHINGTON
Claimant: Greg Hutchison Claimant's Dept.: Grant County Sheriffs Office
Purpose of Claim: lReimbursment for COVID-19 testing Destination:
I PAI4
TOTAL 1 $0.00
unTGr C
MILEAGE
DATE
FRO MtcrrY,ST)
TO(CITY,sT)
MILES
RATE
TOTAL
$0.575
$0.00
$0.575
$0.00
$0.575
$0.00
$0.575
$0.00
$0.575
$0.00
TOTAL 1 $0.00
CHECK-IN DATE CHECK-OUT DATE HOTEL NAME LOCATION (COUNTY, ST) TOTAL
OTHER (receipts required)
DATE DESCRIPTION REASON FOR EXPENSE LOCATION (COUNTY, ST) TOTAL
4/6/2020 Bacteriology/Microbiology testing COVID-19 testing Grant / Washington $263.15
CERTIFICATION
I, the undersigned, do hereby ce _rti under penalty of perjury that the
claim is a just, due unpaid o inst the County, and that l
am authorize o certify aid claim.
Claimant Sign e:
Date: All -
"Amount may be different due to rounding TOTAL[ $263.15
TOTAL REIMBURSEMENT CLAIM I $263.15
Authorization required for Employees:
ELECTED OFFICIAL, DEPARTMENT HEAD, OR DESIGNEE
Name (printed): et tw r 91af
Signature:
Date: /4 2020
Authorization required for County Commissioners or Elected Officials:
COUNTY AUDITOR
Name (printed):
Date:
Authorization required for the County Auditor, Department Heads, meals expenses
outside of travel status, and out of state travel:
COUNTY COMMISSIONERS
(Commissioner
Commissioner:
(Chairman BOCC:
Date:
Statement = SAMARITAN HEALTHCARE
Date 07/01/20 _- — 660 S. COOUDGE DR.
MOSES LAKE, WA 98837
(509) 793-9715
ML2932938
GREGORY A HUTCHISON
1108 W ROSE AVE
MOSES LAKE WA 98837
Amount Paid $
Please Detach at Perforation and Return �Vith Your Remittance
PATIENT NAME
TRANSACTION DATE
GREGORY HUTCHISON
ACCOUNT NUMBER ADMISSION /
DESCRIPTION SERVICE DATE
ML2932938 03/17/20
CHARGES
LAB BACTERIOLOGY/MICROBIOLOGY
277.00
04/06/2.0
HMA Adjustment 41
-13.85
04/06/20
HMA Payment 41
0.00
Estimated Insurance Due:
0.00
Patient Balance:
263.15
We have enjoyed serving you.
Your insurance has been billed.
You may receive an itemized
L
copy of your bill upon request.
SAMARITAN HEALTHCARE You may qualify for free care or a discount on your hospital bill, whether or not you have
TAX ID 91 6001698 insurance. Please contact our financial assistance office at www.samaritanhealthcare.com
or (509) 793-9715.
PLEASE SEE REVERSE SIDE FOR PAYMENT OPTIONS Listed puede calificar para recibir atencion gratuita o un descuento en su facture del hospital,
For Assistance Call (509) 793 9715 sin importar si tiene o no seguro medica. Para comunicarse can nuestra asistencias oficina
de ayuda financiera, visite www.samaritanhealthcare.com or (509) 793-9715.
Barbara Vasquez
From: Emili Wash
Sent: Tuesday, July 21, 2020 2:43 PM
To: Barbara Vasquez
Subject: RE: 7/21 AP Batches
It does, thank you!
Emili Wash, Accounting Clerk 1
509-754-2011 Ext. 2741
-----Original Message -----
From: Barbara Vasquez <bvasquez@grantcountywa.gov>
Sent: Tuesday, July 21, 2020 2:42 PM
To: Emili Wash <eswash@grantcountywa.gov>
Subject: RE: 7/21 AP Batches
LOL last but not least...
It was denied. And this is because our insurance has been amended to cover all costs for Covid testing. Brittany is
working with our insurance and the Sheriff's Office to get it straightened out. There's no place to write "deny" on that
form. Does this email suffice?
Barbara J. Vasquez, CMC
Clerk of the Board
Grant County Commissioners Office
PO Box 37
35 C Street NW
Ephrata, WA 98823
509-754-2011 ext 2928
509-754-6098 (fax)
www.grantcountywa.gov
-----Original Message -----
From: Emili Wash <eswash@grantcountywa.gov>
Sent: Tuesday, July 21, 2020 2:39 PM
To: Barbara Vasquez <bvasquez@grantcountywa.gov>
Subject: RE: 7/21 AP Batches
The other one haha. but thank you for this one haha.
Emili Wash, Accounting Clerk 1
509-754-2011 Ext. 2741
-----Original Message -----
From: Barbara Vasquez <bvasquez@grantcountywa.gov>
Sent: Tuesday, July 21, 2020 2:36 PM
To: Emili Wash <eswash@grantcountywa.gov>
Subject: RE: 7/21 AP Batches
This one? Yep...
Barbara J. Vasquez, CMC
Clerk of the Board
Grant County Commissioners Office
PO Box 37
35 C Street NW
Ephrata, WA 98823
509-754-2011 ext 2928
509-754-6098 (fax)
www.grantcountywa.gov
-----Original Message -----
From: Emili Wash <eswash@grantcountywa.gov>
Sent: Tuesday, July 21, 2020 2:30 PM
To: Barbara Vasquez <bvasquez@grantcountywa.gov>
Subject: RE: 7/21 AP Batches
Did they get a chance to look at that reimbursement claim? I have it included in this total, but if they have not gotten a
chance to look at it, I do not want to process it yet.
Emili Wash, Accounting Clerk 1
509-754-2011 Ext. 2741
-----Original Message -----
From: Barbara Vasquez <bvasquez@grantcountywa.gov>
Sent: Tuesday, July 21, 2020 2:29 PM
To: Emili Wash <eswash@grantcountywa.gov>
Subject: 7/21 AP Batches
Here you go!
Barbara J. Vasquez, CMC
Clerk of the Board
Grant County Commissioners Office
PO Box 37
35 C Street NW
Ephrata, WA 98823
509-754-2011 ext 2928
509-754-6098 (fax)
www.grantcountywa.gov