Copy of Carolina Complete Health Provider Training Attestation

New Provider Orientation, Cultural Competency, EPSDT, and Compliance annual trainings.

To view all of our training and education, please visit our website

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* 1. Please indicate your practice-type:

Primary Care

Specialist

Ancillary

Hospital

Health Department

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* 2. Group Name

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* 3. TIN(s) for the practice/agency

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* 4. Indicate which network(s) you are part of

Carolina Complete Health Standard Plan

Trillium Physical Health Tailored Plan

Partners Physical Health Tailored Plan

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* 5. Your name (First, Last)

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* 6. Title/Role

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* 7. Email

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* 8. Attestation of attendance

By checking this box, I attest that I, or a member of the practice staff, have completed the Carolina Complete Health New Provider Orientation, Cultural Competency, EPSDT, and Compliance annual trainings

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* 9. Date you completed trainings

Date / Time

Date

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* 10. Please provide feedback on how we can improve your training experience

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* 11. From the following list of training topics, please select all those which you would likely attend if offered.

Provider Portal

Appeals Process

Complex Care

Cultural Competency/Health Equity

Filing a Claim

Integrated Care

Resiliency and Trauma-Informed Care

Value-Added Services

Unmet Health Related Resource Needs to include: housing, transportation, food access, interpersonal violence/toxic stress

Tailored Plans, Standard Plans, and Medicaid Managed Care