2024 Model of Care for Providers – Provider Partners Health Plans

Please complete all required fields to ensure accuracy and tracking purposes.

Name*
First Last
Job Title*
Group/Contract Name*
Group TIN
Group NPI*
Provider Plan*
Email*
Enter Email Confirm Email
Direct Phone Number*
Attestation*
- By checking this box, you will be providing Provider Partners Health Plans an electronic attestation of completion. If you would like a hard copy of the MOC and Attestation, please print a copy for your records. Hard copy Attestations can be faxed directly to your Provider Relations Coordinator. Thank you for completing the Provider Partners Health Plans 2024 Model of Care training.
Consent*
I have downloaded the MOC
Before you submit an attestation, you must first download the MOC located here.

Page Last Updated: 7/31/2024