FDR Compliance Attestation

The Compliance Attestation form is used to confirm that the FDR or Affiliate is in compliance with VA Premier FDR and Affiliate Compliance Policy for the Commonwealth Coordinated Care program.

Step 1 of 3

  • First Tier, Downstream, or Related Entity (FDR) and Affiliate Compliance Attestation

    The Compliance Attestation is used to confirm that the FDR or Affiliate is in compliance with VA Premier FDR and Affiliate Compliance Policy for the Commonwealth Coordinated Care program.

    All First Tier, Downstream or Related Entity and Affiliates that are contracted to provide administrative and healthcare services to Medicare and Medicaid enrollees by Virginia Premier CompleteCare must complete a Compliance Attestation. The Attestation must be signed by an authorized representative when the FDR or Affiliate first contract with VA Premier CompleteCare and annually thereafter.

    An authorized representative is a Compliance Officer, Chief Medical Officer, Practice Manager, Executive Officer, Provider, Owner, or equivalent authoritative representative.

    Only one Compliance Attestation form is required for each FDR and Affiliate.

  • Please list any subcontracted or affiliated vendors you currently utilize for any contracted duties assigned to your organization for Virginia Premier’s CompleteCare Program.


By logging in to this portal, I affirm that I have read, understand and agree to abide by the following terms and conditions: 

I certify I am a health care provider, an employee of a health care provider, a business associate of a health care provider, or an employee of a business associate, and the purpose of my access to any Virginia Premier System is related to the provision or payment of health care services.

With respect to all information viewed or obtained from this site, I agree to comply with all applicable federal and state laws regarding the confidentiality and integrity of health and medical records. This includes full compliance with the Health Insurance Portability and Accountability Act of 1996 (‘HIPAA’), the HITECH Act, and the Virginia Health Records Privacy Act, and applicable regulations to these laws.

I agree to keep confidential all information related to Virginia Premier System business, including, but not limited to, quality and risk management activities as well as other confidential or personal information concerning the medical, personal, or business affairs of Virginia Premier System and its members.

I agree to notify Virginia Premier System immediately in the event that my network access has been compromised in any way and in the event of unauthorized use or disclosure of any information obtained from the Virginia Premier System network.

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In order to register for an account, if you would like access to all group NPIs/APIs under a single Tax ID, please enter your Tax ID only. If you would like access to a specific group NPI/API instead, please enter it in the field provided. 

For expedited registration, please provide a Claim number and the Total Billed Charges on the claim when creating your account.

You will receive an email within 3-5 business days with your username and temporary password.

Please call Technical Support for help with Virginia Premier’s Provider Portal at 1-877-814-9909 or email connect@healthtrio.com. 

Virginia Premier is offering EFT services through PaySpan.

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If you have questions or need help please, contact our Provider Services department at vphpnetdev@sentara.com or by calling 804-968-1529.