Individual Attestation Group Attestation
I hereby attest the provider listed below has completed the 2026-2028 EmblemHealth SNP MOC training. I understand this is required by CMS. I declare the above statement is true and accurate to the best of my knowledge. I confirm I hold the authority to make this attestation.
Provider Tax ID Number:
Provider Information:
Information completed by:
Relationship to above-named provider (e.g., self, office manager, nurse, other):
*Required field
I hereby attest the providers associated with the TIN indicated below have completed the 2026-2028 EmblemHealth SNP MOC training. I confirm new providers who join our group will complete the SNP MOC training. My organization agrees to maintain supporting documentation and will furnish evidence of the above to EmblemHealth upon request for monitoring and auditing purposes. I understand this is required by CMS. I declare the above statement is true and accurate to the best of my knowledge. I confirm I hold the authority to make this attestation.
Organization Tax ID Number:
Group/Organization Name:
Center ID:
Relationship to above-named group (e.g., self, office manager, nurse, other):
*Please use this spreadsheet to list each practitioner in the group who currently participates with EmblemHealth Medicare and has completed the training. Submit via email with a subject line that includes your Group/Organization name, Center ID and SNP MOC to SNPMOC_Outreach@emblemhealth.com . (Note: Listing additional practitioners does not constitute network participation.)