Skip to content
CLAS Attestation
Welcome to Blue Complete CLAS Provider Training.
*
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
No
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
No
*
3.
How many people at your organization attended this training session?
(Required.)
*
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
*
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
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
6.
Address
Name
Company
Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Country
Email Address
Phone Number
Current Progress,
0 of 6 answered
