MANDATORY REQUIREMENT

In accordance with guidance from the Centers for Medicare & Medicaid Services (CMS), providers contracted to serve Medica’s Special Needs Plan (SNP) members must complete annual Model of Care (MOC) training.

By completing this survey, you are attesting on behalf of your organization that:
  • Providers in your organization that participate in one or more of Medica’s SNP networks have received the Medica MOC Training.
  • Your organization maintains evidence of providers’ completion of the annual Medica MOC Training and will provide such evidence to Medica upon request.
    • In an audit, CMS will ask for proof that individual providers took the MOC Training.
Medica ND Special Needs Plan (SNP):
  • Medica Advantage® Dual
*This Attestation will serve as the evidence of completion for Medica’s Model of Care, provider training.

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* 1. Name of Person Completing Form (First and Last)

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* 2. Clinic/Practice Name

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* 3. Tax ID (if applicable, enter TIN for all clinics you are attesting on behalf of)

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* 4. Email Address

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* 5. Date Completed

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* 6. I agree that the name entered above is an electronic representation of my signature for the purpose of this Medica SNP Model of Care Training Attestation

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