ADA Training

If you have your own ADA training, complete the attestation form below.

Click the link below and review the ADA Training and disseminate to any individuals or entities you employ or contract to perform administrative or health care services on behalf of NextLevel Health.

ADA Training (PDF)

Complete the Attestation Form below.
The attestation form must be completed by an authorized representative within your organization (i.e., Owner, Compliance Officer, Organization Manager/Administrator or an Executive Officer) to attest to compliance with Medicaid program training requirements.

ADA Training Attestation

Required fields are marked with an asterisk (*)

FIRST NAME *

LAST NAME *

BUSINESS NAME *

EMAIL *

PHONE *

ADDRESS *

CITY*

STATE*

ZIP *

TRAINING ATTESTATION * I certify, as the authorized representative having responsibility directly or indirectly for all employees, contracted personnel, providers/practitioners, and vendors who provide health care or administrative services under Medicaid, that the statements below are true and correct to the best of my knowledge.

Upload a copy of evidence for completing the above training, including the list of names of individuals who completed this course by providing the following information:

Employee First name
Employee Last name
Employee Title
Completed Course Title
Date Course was Completed by Employee

FILE UPLOAD *