For Providers

Required Annual Model of Care Training for CSNP Providers Form

Models of Care (MOC) are considered a vital quality improvement tool and integral component for ensuring that the unique needs of each HealthTeam Advantage Medicare member enrolled in our Chronic Special Needs Plan (C-SNP) are identified and addressed. The Model of Care (MOC) is a high quality, patient-centric medical care delivery system for our C-SNP members and is designed to maintain the member’s health and encourage their involvement in their health care. As a Medicare Advantage C-SNP, HealthTeam Advantage is required by the Centers for Medicare and Medicaid Services (CMS) to provide annual training of its Model of Care, and as a provider who provides the care for one or more of our C-SNP beneficiaries, you are required to complete this training.
I am completing this form as a:*
- Provider
- Staff Member
Attestation Statement*
- I attest that I have completed my own Model of Care (MOC) training.
By appending my name and NPI, I am attesting that I have personally satisfied the annual Model of Care training as required by the Centers for Medicare & Medicaid Services. I understand that reporting completion without completing the training is considered fraudulent and may result in disciplinary action.
Provider Name*
First Last
Provider Email Address*
NPI*
By appending my name, a provider’s name, and provider’s NPI, I am attesting that I have satisfied the annual Model of Care training on behalf of this provider as required by the Centers for Medicare & Medicaid Services. I understand that reporting completion without completing the training is considered fraudulent and may result in disciplinary action.
Attestation Statement*
- I attest that I have completed Model of Care (MOC) training on behalf of an individual practitioner.
Staff Name*
First Last
Staff Email Address*
Provider Name*
First Last
Provider's NPI*
* Indicates required fields

For Providers

Required Annual Model of Care Training for CSNP Providers Form

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