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Attestation Statement (IMPORTANT: Submit Original Only) This application is to be signed by each individual provider submitting an application. Fill in each space with the name of the Health Plan
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How to fill out important submit original only

01
Begin by obtaining the necessary original documents that need to be submitted.
02
Carefully read through the instructions provided by the authority or organization requiring the submission.
03
Make sure you have all the required information and supporting documents ready before starting the submission process.
04
Fill out the submission form or application accurately and completely, ensuring that all the relevant fields are properly filled.
05
Double-check the form and all the attached original documents for any errors or omissions.
06
Once you are confident that everything is filled out correctly, securely package the original documents along with the submission form.
07
If required, make copies of the original documents for your personal records.
08
Submit the package either by mail or in person, following the specified submission guidelines provided by the authority or organization.
09
Keep track of the submission by retaining any receipts or proof of delivery provided.
10
Finally, wait for a response from the authority or organization regarding the status of your submission.

Who needs important submit original only?

01
Individuals or organizations who are required to submit important original documents as part of a legal process, application, or official procedure.
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Important submit original only refers to the requirement of submitting original documents without any copies or duplicates.
Individuals or entities specified by the governing body are required to file important submit original only.
To fill out important submit original only, simply prepare the necessary documents and submit them in their original form.
The purpose of important submit original only is to ensure the authenticity and accuracy of the submitted documents.
On important submit original only, all relevant information specified by the governing body must be reported.
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