Provider Invoice Submission

Provider Invoice Submission

What is the Request ID? (Previously called Job Number, format HPT123456)*

HPT is necessary, there are no spaces nor dashes, and there are 6 numbers. Failure to input job number correctly MAY result in delayed payment processing.

What is your Provider ID?*

If you do not know your provider ID, please check your email. Provider IDs are assigned once a provider has completed the onboarding process.

If you have not received a provider ID yet, PLEASE reach out to our Provider Network Team at (877) 296-2285 and select option 2 after the language selection.

Date of Service*

What type of service did you provide?*

In-Person Interpretation

Virtual Remote Interpretation

Transportation

Document Translation

Actual Pick up Time*

Time Arrived at Appointment*

Appointment End Time*

How long did you wait for the client?

Please input N/A if wait time was not authorized.

Invoice Grand Total (Number Only)*

Total Trip Mileage*

Number of miles traveled with the client in the vehicle

Total Miles Travelled*

Total roundtrip mileage to and from the appointment location

Total Dead Miles

Total roundtrip mileage to and from the pick up point

Please input your best contact email*

Any notes for this service?

Any additional time, rush, before/after hours/no-show information, etc. Any explanation for a difference in quoted price vs invoice total

If you have created your own invoice, you may attach it here

If you have not invoiced us before and have not yet submitted completed paperwork with a W9, please contact our Provider Network Team at (877) 296-2285, option 2 after the language selection.

Drag and drop files here or

Send me a copy of my responses

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