CLAS Attestation

Welcome to Blue Complete CLAS Provider Training.

Question Title

1. Do you attest on behalf of yourself or your agency that you have received materials from and undergone cultural competency training by Blue Cross Complete of Michigan in accordance with state requirements, including:

• The Civil Rights Act of 1964
• Availability of on-site training
• Michigan federally recognized Indian tribes
• Cultural awareness in patient relationships
• Member race, ethnicity and language for my region
• Assessment of my experience with interpretation service
• State training requirements (Required.)

Yes

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2. Do you further attest that all newly hired staff will receive and review the cultural competency materials and resources that you received today, within 30 days of hire, and documentation confirming the same will be maintained in each employee’s personnel file and be available upon request?

Yes

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3. How many people at your organization attended this training session? (Required.)

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4. Enter your contact information (Required.)

Provider or Group Name *

Contact name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

*Group NPI number
(Required - NPI must be valid) *

Email *

Phone Number *

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5. By submitting this attestation, you certify that on this date your responses above are accurate, truthful and complete to the best of your knowledge.

Enter today's date below

Date

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6. Address

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Do you further attest that all newly hired staff will receive and review the cultural competency materials and resources that you received today, within 30 days of hire, and documentation confirming the same will be maintained in each employee’s personnel file and be available upon request?

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* 3. How many people at your organization attended this training session? (Required.)

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* 4. Enter your contact information (Required.)

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* 5. By submitting this attestation, you certify that on this date your responses above are accurate, truthful and complete to the best of your knowledge.

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* 6. Address

2. Do you further attest that all newly hired staff will receive and review the cultural competency materials and resources that you received today, within 30 days of hire, and documentation confirming the same will be maintained in each employee’s personnel file and be available upon request?

3. How many people at your organization attended this training session? (Required.)

4. Enter your contact information (Required.)

5. By submitting this attestation, you certify that on this date your responses above are accurate, truthful and complete to the best of your knowledge.

6. Address