Annual Attestation and Disclosure Statement

Back To Compliance Program

Contracted providers and Subcontractors, with Banner Health Plans (BHP) are required to complete the Annual Attestation and Disclosure Statement. 

Instructions:

1. Review each section:

  • Section 1: Medicare and Medicaid Participation Compliance Program Requirements
  • Section 2: Attestations
  • Section 3: Organization Information and Signature

2. Complete the 2024 Annual Compliance Attestation online here: https://eservices.uph.org  

If you are unable to complete the online form above, below is the PDF version.