FLASH: Complete Health Alliance Attestation Form

We’re committed to making sure our contracted providers are compliant with the Centers for Medicare & Medicaid Services (CMS) guidelines outlined in the Medicare Managed Care Manual and/or Prescription Drug Benefit Manual for services provided on our behalf.

We require First Tier, Downstream and Related Entities (FDRs) under our Medicare Advantage plans, Part D plans or Qualified Health Plans to complete an attestation form annually to show you’ve met the CMS requirement. It must be completed by your organization’s chief executive officer, chief operating officer or compliance officer.

Please complete the attestation form and send it to Provider.Relations@healthalliance.org.

Contact your provider relations specialist with any questions.