Texas Health and Human Services Commission


New Attestation Authorization Form Required for Medicaid Electronic Health Record (EHR) Incentive Program

Starting April 1, eligible professionals (EPs) participating in the Medicaid EHR Incentive Program for Program Year 2017 or later must complete a Third Party Attestation Authorization Form to designate the person who will be attesting on their behalf for EHR incentives. The form allows an EP to authorize a third party to complete the EP's attestation for incentives and to receive notice or communication in connection with the provider's attestation.

The Third Party Attestation Authorization Form can be found at https://hhs.texas.gov/laws-regulations/forms/2000-2999/form-2701-authorization-third-party-attestation

All EPs, including those who are not authorizing a third party attester, must sign and upload this form to the EHR Incentive Program portal prior to receiving an incentive payment. The form can be completed on the computer with a digital signature and uploaded to the Program portal. Alternatively, it can be printed out, signed in ink, and scanned as an electronic file for upload. EPs will be prompted during the attestation process to upload the form through the secure upload function in the portal.