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February 20, 2014 - Reviewed: 04.07.2022

Acceptable Attestations and Signatures

The top reason services are denied, upon medical review, is invalid signature, and no attestation was provided upon request. Failure to submit records with valid signatures upon request, or valid and timely attestations, will result in your claims being denied.

In order to be considered valid for Medical Review purposes, your signature, in all medical records provided to CGS as supporting documentation, MUST:

  • Contain your professional DESIGNATION (e.g., MD, DO, NP…)
  • Contain the date you signed

These requirements are applicable regardless of whether your office or practice submits its own claims or contracts with a billing service.


If the medical records you provide (upon request) do not include a valid signature, CGS will request that you submit a signature attestation. You have 20 days from the date of receipt of the fax from CGS to submit the attestation.

In order for a signature attestation to be valid, it MUST be:

  • Complete with:
    • Beneficiary information (CGS asks for name/date of birth)
    • Legibly printed provider name
    • Date of service you are attesting to
      • ONE date of service per attestation
    • Professional designation (e.g., MD, DO, NP…)
    • Handwritten signature of provider
    • Date the attestation was signed


  • Guidelines regarding signature requirements are located in the CMS Medicare Program Integrity Manual (Pub. 100-08), chapter 3, section, "Signature RequirementsExternal PDF." Information is also available in CMS MLN Matters article MM6698External PDF, "Signature Requirements for Medical Review Purposes."


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