Provider Training Confirmation

After the Alignment Health Plan Special Needs Plan Model of Care Provider Training has been distributed for the current coverage year, please submit confirmation for your Provider Group or as an Individual.

You can submit your confirmation using our online form or fax or email.

I confirm that the Special Needs Plan (SNP) Model of Care (MOC) Training has been distributed via this portal or another appropriate means to the listed providers.

The listed Provider(s) and I understand the Alignment SNP Model of Care and our Organization's responsibility in improving health outcomes for our most vulnerable population.

The listed Providers and I also understand this training is required by the Centers for Medicare and Medicaid Services (CMS) for all Medicare Advantage Providers who care for SNP members.

Send your Confirmation via online form

We highly encourage you to use our new form. As you fill out your information, required fields are marked with an asterisk (*).

Training Information

* I am filling out this form:

For myself
A Group (REQUIRED: List all individuals under the "Additional Individuals Receiving the Training" section below)

* Training Type:

Annual
Onboarding/Newly Contracted

* State:

* County:

Confirming Designee or Provider

* First & Last Name:

* Title:

* Organization Name:

* Phone Number:

* Email Address:

Additional Individuals Receiving the Training

REQUIRED: If you are submitting this form for a Group, enter the first and last names of all individuals who have received Alignment Health Plan's Special Needs Plan (SNP) Model of Care (MOC) Training. Separate names with commas.

* List the first and last names of additional individuals below. If you are only filling out this form for yourself, please enter “N/A”:

Optional: Upload Names via Excel

If you experience difficulty entering names:

1. Download the Excel Template

Download Excel File

2. Complete the Excel Template, save it to your computer and upload the file below.

Upload Excel file:

By clicking Submit, you confirm that the Special Needs Plan (SNP) Model of Care (MOC) Training has been distributed to the listed providers.

Send your Distribution Confirmation via fax or email

If you prefer to send your confirmation via fax or email, download and complete the PDF confirmation.

Representative Confirmation

Please send the document via fax at 1-562-207-4617 or by email at [email protected].

Page last updated on December 31, 2025 | Y0141_26471EN_M