Get the free (ACEP) Program Attestation Form - Molina Health Care
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ATTENDANT CARE ENHANCED PAYMENT (ACE) PARTICIPATION ATTESTATION FORM09/25/2019Dear Valued Provider:
CignaHealthSpring (CHS) CarPlay and STAR+PLUS offers all eligible, CHS credentialed and
contracted
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To fill out the acep program attestation form, follow these steps:
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Carefully read the instructions provided with the form.
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Provide your personal details such as name, contact information, and any relevant identification numbers.
04
Fill out the attestation section by stating your agreement and certifying the accuracy of the information provided.
05
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Submit the form by the specified deadline through the designated method (e.g., mail, email, online submission).
Who needs acep program attestation form?
01
The acep program attestation form is required by individuals who are participating in the ACEP (American College of Emergency Physicians) program. This form is typically needed by emergency physicians, medical students, residents, fellows, and other healthcare professionals who are engaged in ACEP-approved programs or activities.
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What is acep program attestation form?
The acep program attestation form is a document that healthcare providers must fill out to attest that they have met the requirements of the Medicare Electronic Health Record (EHR) Incentive Program, also known as the Medicare and Medicaid EHR Incentive Programs.
Who is required to file acep program attestation form?
Healthcare providers who participate in the Medicare Electronic Health Record (EHR) Incentive Program are required to file the acep program attestation form.
How to fill out acep program attestation form?
To fill out the acep program attestation form, healthcare providers must log in to the Medicare and Medicaid EHR Incentive Programs' online portal and follow the step-by-step instructions to complete the form.
What is the purpose of acep program attestation form?
The purpose of the acep program attestation form is to verify that healthcare providers have met the requirements of the Medicare Electronic Health Record (EHR) Incentive Program in order to receive incentive payments.
What information must be reported on acep program attestation form?
Healthcare providers must report information such as their patient volume, EHR adoption and implementation details, and their compliance with program requirements on the acep program attestation form.
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