DSNP Training Attestation Form

DSNP Training Attestation

The DSNP MOC training is conducted annually to ensure all contracted and non-contracted medical providers and staff receive training on the DSNPs MOC as required by the Centers for Medicare & Medicaid Services (CMS). Completion of the annual MOC training is mandatory for all providers who serve Jefferson Health Plans DSNP members. It is important you complete the below attestation confirming you have completed the course. To record your completion, please check the box marked agree and submit. If you have any questions, please contact providereducation@jeffersonhealthplans.com.

Attestation for Tax ID Number:

Type of Training:

Tax ID Number *

Check the box if this is a newly contracted group

Selected Sites

Method of Training *

Date of Training (MM/DD/YYYY) *

Organization Name *

First Name *

Last Name *

Job Title *

Comments

By checking the box below, I attest I have received and distributed the required training materials to all appropriate staff under the Tax Identification Number(s) entered above. I further attest all appropriate staff members have received and reviewed the training materials.

I Agree