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Provider invoices must contain the following required information:
- the provider's complete name and address (include payment address, if different);
- the provider's contact name and telephone number;
- the provider's 14-digit taxpayer Texas identification number (TIN);
- DARS DBS office name and delivery address;
- the DBS service authorization and/or purchase order number and/or contract number;
- an itemized list of services being billed including quantity and cost of units billed (for example, 3 hours @ $50 each, or 1 evaluation @ $50, etc.);
- dates of service;
- consumer identification information (first name, first initial of last name); and
- the total amount being billed.
The following information is optional:
- the name of the DBS counselor or case manager, and
- the provider's invoice number.