This form is to certify that your IPA/Medical Group along with its downstream providers have completed the mandatory Model of Care (MOC) training for the year 2026.

What Providers Need to Do

  1. Complete training.
  2. Complete and sign this form.
    1.  If it is an IPA/Medical group training, one attestation form should be submitted via email by the individual with the authority to sign on behalf of the group and an attendance roster must also be attached.
  3. Return this form using the “submit” button or via email using the “export to PDF” button if submitting a roster: CAAttestationForms@molinahealthcare.com
 
 





I hereby attest that my IPA/Medical Group’s contracted and credentialed downstream providers have completed the MOC training, and that the information provided in this form is true and accurate. The MSO will produce and provide proof of attestation for its IPAs/Medical Group(s) and downstream providers upon request from health plan. I understand and agree to abide by these standards, requirements, and guidelines.



Attached file: :


By submitting my information via this form, I consent to having Molina Healthcare collect my personal information.
I understand and agree that my information will be used and shared in accordance with Molina Healthcare's Privacy Policy and Terms of Use.

Click to Verify - This site has chosen an SSL Certificate to improve Web site security ABOUT SSL CERTIFICATES Molina - Terms of Use Website Privacy