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ATTACHMENT 3 ATTESTATION STATEMENT FOR SOLICITATION 36C79118R0022___ (name of vendor) hereby agrees and attests to for all facilities listed on Attachment 2 Facility List:(A) Maintain Medicare certification
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How to fill out jm provider-based attestation statement

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How to fill out jm provider-based attestation statement

01
Obtain the required form for the JM provider-based attestation statement.
02
Fill in all the necessary information accurately and legibly.
03
Provide details about the services provided by the JM provider accurately.
04
Make sure to sign and date the attestation statement to certify its accuracy.

Who needs jm provider-based attestation statement?

01
Healthcare providers who are seeking reimbursement for services provided under a JM provider-based model.

What is JM Provider-Based Attestation Statement Doc Template Form?

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JM provider-based attestation statement is a document that certifies that a healthcare provider meets certain requirements for billing under Medicare Part A or B.
Healthcare providers who participate in Medicare Part A or B are required to file JM provider-based attestation statement.
JM provider-based attestation statement can be filled out by providing the required information about the healthcare provider's qualifications and compliance with Medicare regulations.
The purpose of JM provider-based attestation statement is to ensure that healthcare providers are eligible to receive reimbursement under Medicare Part A or B.
JM provider-based attestation statement requires information about the healthcare provider's qualifications, compliance with Medicare regulations, and other relevant details.
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