Get Medicare Attestation Form

Completing the Medicare Attestation Form online is an important step for confirming your compliance with training requirements. This guide provides clear instructions on how to fill out the form correctly and efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the Medicare Attestation Form and open it in your preferred editor.
2. Fill in the completion date of the Coventry Health Care Fraud, Waste, and Abuse training in the designated space, using the format Month/Day/Year.
3. Provide your name by entering your last name followed by your first name in the ‘Name’ field.
4. Input your home address including the street number and name in the ‘Address’ section, ensuring that all details are accurate.
5. Enter your city of residence in the appropriate field.
6. Select your state from the dropdown list.
7. Fill in your phone number, ensuring correct formatting for ease of contact.
8. Provide either your National Provider Identifier (NPI) number or your license number in the corresponding field.
9. Complete the ‘Zip Code’ section by entering the correct postal code.
10. Once you have filled in all required fields, review the form for accuracy before saving changes.
11. Finally, download, print, or share the form as necessary to finalize your submission.

Take action now and complete your Medicare Attestation Form online.