[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-336231-105":53,"doc-detail-336231-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","sample-vendor-invoice","Sample Vendor Invoice","","Vendor billing invoice template containing fields for invoice number and date, Medicaid participant identifiers, billing period start/end dates, provider identification and contact details, and participant discharge status. Includes instructions on grouping service dates by month or pay period, requirements for separate service lines when spanning multiple months, and the timing rule to submit claims only after services are rendered. Provides structured service line entries with procedure codes, units, rates, and line totals, and includes signature sections with IRIS Medicaid Provider Service Agreement compliance confirmation.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":21,"@type":70,"position":76},"https://docshare.wps.com/template/invoices/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/sample-vendor-invoice/336231/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/sample-vendor-invoice/336231.png","ImageObject",442,249,{"name":88,"@type":89},"Patrick","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-16","2026-09-21",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",6,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information does the invoice collect at the top?","Question",{"text":109,"@type":110},"It captures the invoice number and invoice date, along with Medicaid ID, DOB, and participant first and last name details, plus a place for pre-authorization number.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How should service dates be grouped on the invoice?",{"text":114,"@type":110},"Service dates may be grouped by month or by pay period. If service dates span multiple months, use separate service lines.",{"name":116,"@type":107,"acceptedAnswer":117},"When should claims be submitted, and what do signatures confirm?",{"text":118,"@type":110},"Submit claims only after services have been rendered. Provider signature confirms compliance with the IRIS Medicaid Provider Service Agreement outlined on the back of the form, and participant signature includes the participant date.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},336231,1791000285,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":20,"category_name":21,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":4},549758146520,"https://ap-avatar.wpscdn.com/avatar/80002397d8c0411e94?_k=1775819394049821470","Invoice Number: 12345  Invoice Date: 03/31/2016  Use this form for IRIS-funded, non-HIPAA claims only.  \n\n| Medicaid ID:\u003Cbr>1234567890 | DOB:\u003Cbr>01/01/1970 | Participant First Name: John | Middle: | Participant Last Name: Doe | Pre-authorization Number: |\n| --- | --- | --- | --- | --- | --- |\n\n\n| Billing Period Dates:\u003Cbr>Billing Start Date:03 /  01/ 2016 \u003Cbr>Billing End Date: 03 / 31/ 2016  | Provider Name: ABC Corp.\u003Cbr>_____________________________\u003Cbr>_____________________________ | Provider ID (see instructions on reverse):  12-3456789 \u003Cbr>Phone:   |  |\n| --- | --- | --- | --- |\n| Provider Address (Street):\u003Cbr>123 W. Main Street\u003Cbr>_____________________________\u003Cbr>_____________________________ | Provider Address (City, State, Zip): Your Town, WI 12345 \u003Cbr>_____________________________ | Provider Contact Person: Jane Doe\u003Cbr>Phone: ( 123) 456-7980  | Participant\u003Cbr>Discharge Status: |\n\nService dates may be grouped by month or by pay period. Invoices submitted before the due date will be processed and paid on the next pay date. If you prefer to be paid more frequently, submit your invoices on a bi-weekly basis per the Vendor Schedule.  \nEach service line may only include dates from one calendar month. If your service dates span multiple months, use separate service lines. Submit claims only after services have been rendered.  \n\n|  |  |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| S8990 | Grouped by\u003Cbr>month. | 03/01/2016 | 03/31/2016 | Physical Therapy | Paid | V9. |  | Day | $65.00 | 10.00 | $650.00 |\n|  |  |  |  |  |  |  |  |  |  |  |  |\n| S8990 |  | 03/01/2016 | 03/12/2016 | Physical Therapy | Paid | V7. |  | Day | $65.00 | 2.00 | $130.00 |\n|  |  |  |  |  |  |  |  |  |  |  |  |\n| S8990 | Grouped by\u003Cbr>pay period. | 03/13/2016 | 03/26/2016 | Physical Therapy | Paid | V8. |  | Day | $65.00 | 2.00 | $130.00 |\n| S8990 |  | 03/27/2016 | 03/31/2016 | Physical Therapy | Paid | V9. |  | Day | $65.00 | 6.00 | $390.00 |\n\nProvider Signature:  John Doe   \nSignature confirms compliance with the IRIS Medicaid Provider Service Agreement outlined on the back of this form.  \nParticipant Signature:  Jane Doe  Date:  03/31/2016   \nTOTAL $ $1300.00  \nSAMPLE","cbCait8BwZJVk6Ov","https://ap.wps.com/l/cbCait8BwZJVk6Ov","pdf",482743,"English","# Invoice Details\n## Billing Period, Provider, and Participant Information\n## Service Line Entries and Totals\n## Signatures and Compliance Statement","[{\"question\":\"What information does the invoice collect at the top?\",\"answer\":\"It captures the invoice number and invoice date, along with Medicaid ID, DOB, and participant first and last name details, plus a place for pre-authorization number.\"},{\"question\":\"How should service dates be grouped on the invoice?\",\"answer\":\"Service dates may be grouped by month or by pay period. If service dates span multiple months, use separate service lines.\"},{\"question\":\"When should claims be submitted, and what do signatures confirm?\",\"answer\":\"Submit claims only after services have been rendered. Provider signature confirms compliance with the IRIS Medicaid Provider Service Agreement outlined on the back of the form, and participant signature includes the participant date.\"}]","Sample Vendor Invoice | PDF",1790014209]