Volume III - Fee for Service Billing

The data fields to be used when creating an input record are marked with Y, N, or NA under the column titled "RQD" (Required). Fields marked with Y are required input fields on the transaction. Fields marked with N are optional input fields. Fields marked with NA (not applicable) should contain spaces or zeros as specified on the input record. Unless stated otherwise, numeric fields should be right justified and zero filled, and alphanumeric fields should be left justified and space filled.

After processing, when the diskette is returned to the agency, the record will contain the same data that was reported for input plus certain fields (marked as NA for input and specified to contain returned data) will contain information concerning the status of the transactions. The records in the provider file will be returned in sequence number, provider ID, and provider ID suffix order. The records in the client financial information file will be returned in sequence number, provider ID, individual ID, and effective date order. The records in the billing file will be returned in sequence number, fiscal year, service date, individual ID, provider ID, provider ID suffix, and program code order. A voucher file will also be returned containing voucher numbers for each billing transaction that was accepted in sequence number order.

Detailed descriptions of the record layouts are on the following pages.

  1. 3.1 Provider Record Format
  2. 3.2 Provider Trailer Record Format
  3. 3.3 Client Financial Information Record Format
  4. 3.4 Client Financial Information Trailer Record Format
  5. 3.5 Billing Record Format
  6. 3.6 Billing Trailer Record Format
  7. 3.7 Voucher Record Format

3.1 Provider Record Format

FIELD NAME LENGTH POSITION FORMAT RQD DESCRIPTION
Entry Agency FEIN 9 1-9 numeric Y The agency's nine digit Federal Employer Identification Number (FEIN). This is for the agency submitting the data.
Action Code 1 10-10 alpha Y
  • Action for processing the transaction.
  • Valid values are:
  • A - add/submit new provider information to DHS.
  • C - change provider
  • information previously accepted by DHS.
Service Provider FEIN Number 9 11-19 numeric Y The service provider's nine digit Federal Employer Identification Number (FEIN).
FEIN Suffix 4 20-23 numeric Y If a suffix is not assigned by your agency, value = all zeros.
Taxpayer ID (FEIN) Number Type 2 24-25 alpha Y
  • Taxpayer ID number type approved by the Comptroller's Office.
  • Valid values are:
  • 01 - Federal Employer Identification Number
  • 02 - Social Security Number.
  • 03 - Government Unit Code.
  • 04 - Comptroller-assigned number for certain non reportable payments.
  • 05 - Vendor awaiting Taxpayer ID number assignment.
  • 06 - Comptroller-assigned number for nonresident alien, foreign corp or foreign partnership.
Filler 4 26-29 alpha N/A Value = spaces
Provider Type 1 30-30 alpha Y Value = S. Indicates Fee For Services provider.
Start Date 8 31-38 numeric Y
  • Date on which the provider began providing services.
  • Format: century, year, month, day.
Termination Date 8 39-46 numeric Y
  • Date on which the provider stopped providing services.
  • Format: century, year, month, day.
  • If the provider is active, value = 99990101.
Provider Name 30 47-76 alpha Y
  • Provider's legal name.
  • When Taxpayer ID (FEIN) Number Type = 02, this field is divided by.,last name, space, first name, space, title.
Provider Address Address 1 30 77-106 alpha Y Street or box number.
Provider Address Address 2 30 107-136 alpha N Additional address information, if needed.
City 17 137-153 alpha Y City.
State 2 154-155 alpha Y Post Office abbreviation for state.
Zip Code 5 156-160 numeric Y Post Office designation for zip code.
Zip Suffix 4 161-164 numeric N Post Office designation for zip code suffix.
Attention 25 165-189 alpha N Name to whom daily mail will be addressed.
Telephone Nbr 10 190-199 numeric Y Provider area code and general number. If unavailable, enter all nines.
Telephone Ext 4 200-203 numeric N Extension of provider telephone number.
Filler 2 204-205 alpha NA Value = spaces
County 3 206-208 numeric Y Provider county. Refer to the current State of IL Directory of Geographic Info.
Township/Comm Area 2 209-210 numeric Y Provider township/ community area. Refer to the current State of IL Directory of Geographic Info.
Filler 2 211-212 numeric NA Value = 00 (zeros)
Control Type 1 213-213 alpha Y
  • Operator of business.
  • Valid values are:
  • I - Individual
  • S - Sole Proprietorship
  • P - Partnership
  • C - For Profit Corporation
  • N - Not-for-Profit Corporation
  • R - Real Estate Agent
  • K - County Agency
  • G - Other Government Agency
  • E - Trust/Estate
  • H - Medical/Health Care Corp
  • T - 501(a) Tax Exempt
Bank Account Number 17 214-230 alpha N Bank account number if warrant is to be mailed to a bank.
Warrant Name 30 231-260 alpha N Name of person or business where warrant is to be mailed.
Warrant Address 1 30 261-290 alpha N Street or box number where warrant is to be mailed.
Warrant Address 2 30 291-320 alpha N Additional address information where warrant is to be mailed.
Warrant City 17 321-337 alpha N Community where warrant is to be mailed.
Warrant State 2 338-339 alpha N Post Office abbreviation where warrant is to be mailed.
Warrant Zip 5 340-344 numeric N Post Office designation for zip code where warrant is to be mailed.
Warrant Zip Code Suffix 4 345-348 numeric N Post Office designation for zip code suffix where warrant is to be mailed.
Warrant Telephone Number 10 349-358 numeric N Area code and general number where warrant is to be mailed.
Warrant Extension 4 359-362 numeric N Extension of telephone number where warrant is to be mailed.
Filler 2 363-364 alpha NA Value = Spaces
Submittal Date 8 365-372 alpha Y

Date the transaction was written to the file for submission to DHS.

Format: century, year, month, day
Filler 6 373-378 numeric NA Value = all zeros. This field is used only at DHS.
Reject Code 2 379-380 alpha NA
  • Leave this field blank.
  • Value: spaces
  • This field is returned after DHS has processed the record.
  • Accepted = space
  • Rejected = Contains a code indicating reason the transaction was not accepted by DHS.
Filler 1 381-381 alpha NA Value = space. Used by DHS only.
Filler 1 382-382 alpha Y Value = Z
Filler 18 383-400 alpha NA Value = Spaces

3.2 Provider Trailer Record Format

FIELD NAME LENGTH POSITION FORMAT RQD DESCRIPTION
Entry Agency FEIN 9 1-9 numeric Y The agency's nine digit Federal Employer Identification Number (FEIN). This is for the agency submitting the data.
Filler 1 10-10 alpha Y Value = T
Filler 13 11-23 numeric Y Value = all nines (9)
Record Identifier 7 24-30 alpha Y
  • Value = TRAILER
  • Used to identify this record as the trailer record.
Record Count 7 31-37 numeric Y A count of the total number of records submitted on this file. This count should include the trailer record.
Filler 7 38-44 numeric NA Value = all zeros
Agency Name 30 45-74 alpha Y Agency Name
Filler 290 75-364 alpha NA Value = Spaces
Submittal Date 8 365-372 alpha Y
  • Date the file was submitted to DHS.
  • Format: century, year, month, day
Filler 6 373-378 numeric NA Value = all zeros
Filler 3 379-381 alpha NA Value = all spaces
Filler 1 382-382 alpha Y Value = Z
Filler 18 383-400 alpha NA Value = all spaces

3.3 Client Financial Information Record Format

FIELD NAME LENGTH POSITION FORMAT RQD DESCRIPTION
Entry Agency FEIN 9 1-9 numeric Y The agency's nine digit Federal Employer Identification Number (FEIN). This is the FEIN of the provider submitting the file.
Individual ID (SSN) 9 10-18 numeric Y Social Security Number of the individual receiving service.
Effective Date 6 19-24 numeric Y
  • Starting date on which the client financial information should be used in rate calculations.
  • Format: YYYYMM
  • YYYY = century & year
  • MM = month
Previous Effective Date 6 25-30 numeric N
  • Only report a date in this field if you want to change the effective date of a previous accepted Client Financial Information record.
  • Format: YYYYMM
  • YYYY = century & year
  • MM = month
  • The date in this field, should match the effective date of a previously accepted record.
Individual Name First name 9 31-39 alpha Y First name of the individual receiving services.
Individual Name Middle initial 1 40 alpha Y Middle initial of the individual receiving services.
Individual Name Last name 14 41-54 alpha Y Last name of the individual receiving services.
Filler 8 55-62 alpha NA

Leave this field blank.

Value: spaces
Indicator 1 63 alpha Y
  • Valid values:
  • E - Report E for all individuals.
Record Type 1 64 numeric Y
  • Valid values:
  • 0 - Report 0 (zero) for all individuals.
Average Monthly Earned Income 7 65-71 numeric Y
  • The projected average monthly earned income, based on past earnings and anticipated future earnings, for the effective time period. If $0, report all zeros 0000000.
  • Format = 9(5)V99.,Example: report $150.00 as 0015000
SSI Amount 7 72-78 numeric Y
  • The monthly Supplemental Security Income for the effective time period. If $0, report all zeros 0000000.
  • Format = 9(5)V99
  • Example: report $150.00 as 0015000
SSDI Amount 7 79-85 numeric Y
  • The monthly Social Security Disability Insurance benefit for the effective time period. If $0, report all zeros 0000000.
  • Format = 9(5)V99.,Example: report $150.00 as 0015000
Veteran Award Amount 7 86-92 numeric Y
  • The monthly veteran's award benefit for the effective time period. If $0, report all zeros 0000000.
  • Format = 9(5)V99
  • Example: report $150.00 as 0015000
Railroad Retirement Amount 7 93-99 numeric Y
  • The monthly Railroad Retirement benefit for the effective time period. If $0, report all zeros 0000000.
  • Format = 9(5)V99
  • Example: report $150.00 as 0015000
Insurance Amount 7 100-106 numeric Y
  • The monthly private insurance benefit for the effective time period. If $0, report all zeros 0000000.
  • Format = 9(5)V99
  • Example: report $150.00 as 0015000
CHAMPUS Amount 7 107-113 numeric Y
  • The monthly CHAMPUS benefit for the effective time period. If $0, report all zeros 0000000.
  • Format = 9(5)V99
  • Example: report $150.00 as 0015000
HUD Allowance 7 114-120 numeric Y
  • The monthly HUD allowance for the effective time period. If 0, report all zeros 0000000.
  • Enter a percent - Format = 9(5)V99
  • Example: report 29.8% as 0002980
Other Amount 7 121-127 numeric Y
  • Any other monthly income for the effective time period. If $0, report all zeros 0000000.
  • Format = 9(5)V99
  • Example: report $150.00 as 0015000
Provider Remarks 76 128-203 alpha N Explanatory notes for the provider to use, if desired.
DHS Remarks 76 204-279 alpha NA
  • Leave this field blank.  Value: spaces
  • This field is returned after DHS has processed the record.
  • Explanatory notes from the results of DHS processing are returned in this field. For example, if the SSI amount you reported is different from the SSI amount found on file at the Social Security Administration, it will be overwritten and will be noted here.
Submit Date 8 280-287 numeric Y
  • Date the record was written to the file for submission to DHS.
  • Format: YYYYMMDD
  • YYYY = century & year
  • MM = month
  • DD = day
Filler 6 288-293 alpha NA Leave this field blank.  Value: spaces
Status 1 294 alpha NA
  • Leave this field blank.  Value: spaces
  • This field is returned after DHS has processed the record.
  • Returned values:
  • A - accepted by DHS
  • R - Rejected by DHS
Reject Code 2 295-296 alpha NA
  • Leave this field blank.  Value: spaces
  • This field is returned after DHS has processed the record.
  • If Status = A (accepted by DHS), the reject code is not applicable and will be spaces.
  • If Status = R (rejected by DHS), the reject code will contain a code indicating the reason the record was not accepted by DHS.
Software Indicator 1 297 alpha Y Value = Z
DHS Process Date 8 298-305 numeric NA
  • Leave this field blank.  Value: spaces
  • This field is returned after DHS has processed the record.
  • Date the record was processed by DHS.
  • Format: YYYYMMDD
  • YYYY = century & year
  • MM = month
  • DD = day
Filler 95 306-400 alpha NA Leave this field blank.  Value: spaces

3.4 Client Financial Information Trailer Record Format

FIELD NAME LENGTH POSITION FORMAT RQD DESCRIPTION
Entry Agency FEIN 9 9-Jan numeric Y The agency's nine digit Federal Employer Identification Number (FEIN). This is the FEIN of the provider submitting the file.
Filler 15 24-Oct alpha Y Report all 9's - Value = 999999999999999
Filler 21 25-45 alpha NA Leave this field blank.  Value: spaces
Record Identifier 7 46-52 alpha Y
  • Value = TRAILER
  • Used to identify this record as the trailer record.
Record Count 7 53-59 numeric Y A count of the total number of records submitted on this file. This count should include the trailer record.
Filler 7 60-66 alpha NA Leave this field blank.  Value: spaces
Agency Name 30 67-96 alpha Y Agency Name
Filler 200 97-296 alpha NA Leave this field blank.  Value: spaces
Software Indicator 1 297 alpha Y Value = Z
Filler 103 298-400 alpha NA Leave this field blank.  Value: spaces

3.5 Billing Record Format

FIELD NAME LENGTH POSITION FORMAT RQD DESCRIPTION
Entry Agency FEIN 9 9-Jan numeric Y The agency's nine digit Federal Employer Identification Number (FEIN). This is for the agency submitting the data.
Fiscal Year 4 13-Oct numeric Y
  • Fiscal year of the service being billed.
  • Format: century, year
Service Date 6 14-19 numeric Y
  • Date of the service being billed.
  • Format: century, year, month
Individual ID 9 20-28 numeric Y Social Security Number of the individual receiving service.
Service Provider FEIN Number 9 29-37 numeric Y The service provider's nine digit Federal Employer Identification Number (FEIN).
FEIN Suffix 4 38-41 numeric N
  • If a suffix is not assigned by your agency, value = all zeros.
  • Note: Effective March 1, 2005, non-zero FEIN suffix is only valid for program codes 69, 70, 75, and 76.
Program Code 3 42-44 alpha Y DHS program code through which services were provided.
Filler 1 45-45 alpha NA Value = space
Filler 1 46-46 numeric NA Value = zero
Service Code 2 47-48 alpha Y
  • This is a multi-purpose field and should be used based on what DHS program code number through which services were provided.
  • 1) For Bogard Specialized Services programs, indicate the appropriate service setting (used for rate determination).
  • Valid values:
  • I - Individual
  • G - Group
  • 2) For In-Home Respite DD (87D) report the rate level
  • Valid values: 1, 2, or 3
  • 3) For Residential Respite DD(89D), report the resident location number. Note: Report both digits, (i.e., report 1 as 01, etc)
  • Valid values: 01 - 99
  • 4) For Personal Support (55D), report the entry number.
  • Valid values: 1 - 5
  • 5) For Behavioral Intervention & Treatment (56U), report the provider type.
  • Valid values:
  • 1- Clinical Psychologist or Board-certified Behavior Analyst
  • 2 - Other
  • 6) For Emergency Home Response (55W), report the charge type.
  • 1 - One-time Installation
  • 2 - Monthly Fee
  • 7) Effective Fiscal Year 2019, for program codes 30U, 31A, 31U, 37U, 38U, 39G, 39U, 53D and 53R, report the rate level. New program code 31C, is effective April 1, 2019. Report the rate level for 31C.
  • Rate level 1 is the statewide rate. Rate level 2 is the Chicago rate.
  • New program code 31V effective 9/1/2020. Report the rate level. Statewide rate for both levels.
  • Valid values: 1 or 2
  • 8) For all other programs, leave this field blank.
  • Value = all spaces
  • 8) Effective 01/01/2022 for new program codes 33G, 38C, 61H, 62H, 63H and reactivated program codes 36G, 36U, 38U Deactivating program codes 31S, 39G, 39U continue to allow 2021 reporting.
  • Edits for day program bill codes 31U, 31C, 31V, 35U, 37U, 36G, 38U, 33G, 38C not to exceed 5 hours/day Edits for day program bill code 36U not to exceed 8 hours/day Edits for hourly intermittent CILA bill codes 61H, 62H, 63H not to exceed 10 hours/day Edits for day program bill codes 31C, 31U, 33G, 35U, 36G, 37U, 38C, 38U not to exceed 115 hours/month Edits for day program bill code 36U not to exceed 50 hours/month Edits for hourly Intermittent CILA bill codes 61H, 62H, 63H not to exceed 90 hours/month
  • Rate level is the statewide rate.
  • 9) Effective 02/08/2022 Adjusted rates for program codes 31C, 31U, 39U, 61H, 62H, & 63H. Adusted the maximum umber of daily hours for program codes 31C, 31U, 39G, and 39U to 7 hours per day prior to 01/01/2022
  • 10) Effective 04/01/2022 new bill code 53S. Corrected RATE LEVEL for 36U and 36G.
  • 11) Effective 1/1/2025: New Program Codes: 55E for HBS Personal Support Worker (PSW), Regular Hours, workers who are EVV Exempt. 55F for HBS Personal Support Worker (PSW), Overtime Hours, workers who are EVV Exempt. Clarification of Existing Program Codes: 55D for HBS Personal Support Worker (PSW), Regular Hours, workers must validate through EVV. 55O for HBS Personal Support Worker (PSW), Overtime Hours, workers must validate through EVV.
Billing Unit 1 49-49 alpha Y
  • Program billing unit.
  • E - event
  • H - hourly
  • D - per diem
Total Monthly Service Units (5) (50-54) alpha Y Format depends upon billing unit. Report only one type - event or hourly or per diem data.
Event 5 50-54 alpha Y
  • Total number of service events for the month.
  • Value range:  00001-00279
Hourly 3 50-52 alpha Y
  • Total hours of service for the month.
  • Value range: 000-744
2 53-54 alpha Y
  • Total minutes of service for the month.
  • Value range: 00-59
Per Diem 5 50-54 alpha Y
  • Total number of present and bedhold days.
  • Value range: 00000-00031
Rate 5 55-59 numeric Y
  • Program top-line rate (hourly and per diem programs only).
  • Format: 9(3)V99
Monthly Charge 7 60-66 numeric Y
  • Total monthly charge.
  • Format: 9(5)V99
Mileage 6 67-72 numeric Y
  • For the In-Home Respite program (codes 87D and 87M), report the amount due for mileage.
  • Format: 9(4)V99
  • For all other programs, report 000000
Number of Overnight Stays 2 73-74 numeric Y
  • For the In-Home Respite program (codes 87D and 87M), report the number of overnight stays due for reimbursement.
  • Valid values: 01-31
  • For all other programs, report 00.
Filler 1 75-75 alpha NA Value = space
Processing Flags 2 76-77 alpha Y
  • Combination of codes which indicate the necessary processing at DHS.
  • F - Not yet paid by DHS
  • AP- Adjustment to a previously paid request for payment
  • DP- Void a previously paid request for payment
Site ID 9 78-86 alpha N

Description: Staff ID Field has been repurposed effective 1/1/2024.

Only for program codes 31C, 31U, 31V, 32G, 33G, 34G, 34U, 36G, 36U, 37U, 38C, 38U, 53D, 53R, and 53S with service date of January 1, 2024 or later a DD Site ID is Required. Other program codes and program codes listed above with service date before January 1, 2024 no Site ID is required. DD Site ID is selected from agency DD Site ID List associated with Program Code. DD Site ID Required for all bill codes listed above for all services on and after January 1, 2024. DD Site IDs range in size from 1 to 8 numeric digits. DHS ROCS auto formats DD Site ID in data transfer file.

Format:  Value Range: 0 - 999999999
From Date 2 87-88 numeric Y First day of service billed for the month. Value range: 01-31
Thru Date 2 89-90 numeric Y Last day of service billed for the month. Value range: 01-31
Individual First Name 9 91-99 alpha Y First name of the individual receiving services.
Individual Mid Initial 1 100-100 alpha N Middle initial of the individual receiving services.
Individual Last Name 14 101-114 alpha Y Last name of the individual receiving services.
Problem Area 2 115-116 alpha Y
  • Problem area of the individual receiving service.
  • DD - developmental disability
  • DL - dual disabilities
Optional Data 10 117-126 alpha N For agency use only.
Daily Units (217) (127-343) alpha Y Units of service for each day of the month for which services are being billed. The format depends upon the billing unit (position 49). There are 31 occurrences and each daily value is 7 positions. Each occurrence relates to the services provided on that specific day of the month. Occurrence 1 is for services that occurred on the first day of the month, etc.
Exp. for Day 01: 6 127-132 numeric Y
  • Total dollar amount billed DHS for the day.
  • Format: 9(4)V99
Event Day1 1 133-133 numeric Y
  • Total number of events for the day.
  • Value range: 1-9
Hourly Day1 2 127-128 numeric Y
  • Total service hours for the day.
  • Value range: 0-24
2 129-130 numeric Y
  • Total service minutes for the day.
  • Value range: 00-59
3 131-133 numeric Y Value = zeros
Per Diem Day1 1 127 alpha Y
  • Valid values:
  • P = present
  • A = absent
  • Bed-hold values:
  • H = Hospitalization
  • C = Convalescent care
  • S = Short term SODC
  • F = Family/home visit
  • I = Incarceration
6 128-133 alpha Y Value = spaces
Satellite Code 2 344-345 numeric Y An organizational subpart within an agency that has a unique physical location, but does not have a different FEIN assigned to it. This code is assigned by DHS. If no satellite code is assigned, report zeros in this field.
Submit Date 8 346-353 alpha Y
  • Date the record was written to the file for submission to DHS.
  • Format: century, year, month, day
Filler 6 354-359 numeric NA Value = zeros. This field is only used at DHS.
Filler 1 360-360 alpha NA Value = space
Reject Code 2 361-362 alpha NA
  • Leave this field blank.
  • Value: spaces
  • This field is returned after DHS has processed the record.
  • Accepted = space
  • Rejected = Contains a code indicating reason the transaction was not accepted by DHS.
Filler 1 363-363 alpha NA Value = space
Filler 1 364-364 alpha Y Value = Z
Cycle Date 6 365-370 numeric Y
  • For first time billing, report all zeros.
  • For adjustments or voids (when processing flags (positions 76-77) = AP or DP)), report the value returned by DHS processing of the original bill.
  • Format: CCYYMM
  • century, year, month
CRBCS Sequence Number 4 371-374 numeric Y
  • For first time billing, report all zeros.
  • For adjustments or voids (when processing flags (positions 76-77) = AP or DP)), report the value returned by DHS processing of the original bill.
Filler 8 375-382 alpha NA Value = spaces
Unit Number 2 383-384 alpha Y

Only required when:

  • 1. Program code is:
  • 31U - Dev. Training
  • 36U - Employment Subs. Individual
  • 36G - Employment Subs. Group
  • 39U - Supported Employment Indv
  • 39G - Supported Employment Group
  • 38U - Reg. Work /Sheltered Employment

and

  • 2. When a unit is assigned to the corresponding grant program 310, 380, 390.
  • Leave this field blank(spaces), if no unit number is assigned to the corresponding grant funded program.
Payee Provider FEIN Number 9 385-393 numeric Y The payee provider's nine digit Federal Employer Identification Number (FEIN).
Payee Provider FEIN Suffix 4 394-397 numeric Y If a suffix is not assigned by your agency, value = all zeros.
Filler 3 398-400 alpha NA Value = spaces

3.6 Billing Trailer Record Format

FIELD NAME LENGTH POSITION FORMAT RQD DESCRIPTION
Entry Agency FEIN 9 9-Jan numeric Y The agency's nine digit Federal Employer Identification Number (FEIN). This is for the agency submitting the data.
Filler 36 Oct-45 numeric Y Value = all nines (9)
Record Identifier 7 46-52 alpha Y
  • Value = TRAILER
  • Used to identify this record as the trailer record.
Record Count 7 53-59 numeric Y A count of the total number of records submitted on this file. This count should include the trailer record.
Filler 7 60-66 numeric Y Value = all zeros
Agency Name 30 67-96 alpha Y Agency Name
Filler 249 97-345 alpha NA Value = spaces
Submittal Date 8 346-353 alpha Y
  • Date the file was submitted to DHS.
  • Format: century, year, month, day
Filler 6 354-359 numeric NA Value = all zeros
Filler 4 360-363 alpha NA Value = all spaces
Filler 1 364-364 alpha Y Value = Z
Filler 36 365-400 alpha NA Value = all spaces

3.7 Voucher Record Format

FIELD NAME LENGTH POSITION DESCRIPTION
Entry Agency FEIN 9 1-9 The agency's nine digit Federal Employer Identification Number (FEIN). This is for the agency submitting the data.
Filler 6 10-15 This field is only used at DHS.
Fiscal Year 4 16-19
  • Fiscal year of billing transaction.
  • Format: century, year
Record Type 1 20-20
  • Record type of billing transaction.
  • Value: S (Fee For Services)
Service Provider FEIN Number 9 21-29 The service provider's nine digit Federal Employer Identification Number (FEIN).
Service Provider FEIN Suffix 4 30-33 If a suffix is not assigned by your agency, value = all zeros.
Filler 6 34-39 Not Used.
Program Code 3 40-42 DHS program number through which services were provided.
Filler 1 43-43 Not Used.
Service Code 1 44-44
  • Indicates individual or group program rate for Bogard Specialized Services only.
  • I - individual
  • G - group
  • space - NA (All other programs)
Filler 4 45-48 Not Used.
Service Date 6 49-54 Date of the corresponding billing transaction. Format: century, year, month
Individual ID 9 55-63 Social Security Number of the individual receiving service.
DHS Voucher Info Number 7 64-70 Voucher number.
DHS Voucher Info Suffix 3 71-73 Voucher suffix.
DHS Voucher Info Date 8 74-81 Date the voucher was produced. Format: century, year, month, day
Fund Code 2 82-83 Funding code voucher was paid from.
Amt Paid 7 84-90
  • Amount paid on the voucher for this billing.
  • Format: 9(05)V99
C/D Ind 1 91-91
  • Indicates whether amount paid was a credit/debit.
  • C - Credit (negative)
  • D - Debit (positive)
Cycle Date 6 92-97 Date DHS processed the billing transaction. Format: century, year, month
Cycle Seq 2 98-99 Sequence number of the billing cycle.
Filler 31 100-130 Not Used.

NOTE: This file is not sent to DHS. It is returned to the agency after the requests for payment have been accepted.