FDR Compliance Attestation


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

MediGold's FDRs, including providers such as doctors, skilled nursing facilities, home health agencies and medical groups are required by the Centers for Medicare & Medicaid Services (CMS) to satisfy certain compliance requirements each year. MediGold requires FDRs to provide proof they have satisfied these CMS compliance requirements. This is usually done by the FDR completing and submitting an attestation to MediGold proving they have satisfied the CMS compliance requirements. 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 10/2018