FDR Compliance Attestation

Annual First-Tier, Downstream or Related Entities (FDR) Compliance Attestation

MediGold is committed to maintaining an effective compliance program due to our participation with Medicare. The Centers for Medicare & Medicaid Services (CMS) requires plans to follow certain compliance requirements as part of their contract.

MediGold will continue to ask First Tier, Downstream and Related Entities (FDRs) to complete an annual attestation affirming they are meeting CMS standards and guidelines relating to delegated functions.  The easiest way to provide proof is to click on the FDR Compliance Attestation link below and complete and submit the form. When you successfully complete the form online you will receive a confirmation number. Failure to complete and submit the attestation form to MediGold may lead to corrective action.

FDR Attestation Form


NOTE:  If you contract with an offshore vendor to provide services on behalf of MediGold, you must complete an additional form on behalf of that vendor. Please print, fill-in and submit to MediGold at the address listed below.

FDR Offshore Subcontractor Attestation


MediGold Compliance Officer
6150 East Broad Street, Suite EE320
Columbus, OH 43213-1574


Updated 01/2020