Home
Forms Library
Standard Authorization, Attestation and Release

Standard Authorization, Attestation and Release 2025

Standard Authorization, Attestation and Release Preview on Page 1

Show details

4 out of 5

26 votes

The document is a Standard Authorization, Attestation and Release form required for healthcare providers applying for participation, membership, or clinical privileges with specified healthcare organizations. It outlines the applicant's obligation to provide accurate information for credentialing, authorizes investigations into their qualifications and disciplinary history, and releases entities from liability regarding the information shared during this process. The applicant acknowledges that acceptance is not guaranteed and agrees to notify the entity of any material changes in their application.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to quickly redact Standard Authorization, Attestation and Release online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Dochub is a perfect editor for updating your forms online. Follow this straightforward guide to redact Standard Authorization, Attestation and Release in PDF format online free of charge:

Register and sign in. Register for a free account, set a strong password, and go through email verification to start managing your templates.
Upload a document. Click on New Document and select the form importing option: upload Standard Authorization, Attestation and Release from your device, the cloud, or a protected URL.
Make adjustments to the sample. Take advantage of the upper and left panel tools to modify Standard Authorization, Attestation and Release. Add and customize text, pictures, and fillable areas, whiteout unnecessary details, highlight the important ones, and provide comments on your updates.
Get your paperwork accomplished. Send the sample to other parties via email, create a link for quicker document sharing, export the sample to the cloud, or save it on your device in the current version or with Audit Trail included.

Explore all the advantages of our editor right now!

See more Standard Authorization, Attestation and Release versions

We've got more versions of the Standard Authorization, Attestation and Release form. Select the right Standard Authorization, Attestation and Release version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2010	4.8 Satisfied (22 Votes)
2008	4 Satisfied (26 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What does attestation mean on CAQH?

Attesting to your CAQH application means youre verifying that all your information is accurate and updated. Youll also be reminded to attest to the information in your profile every 120 days. If you fail to attest or re-attest to your CAQH information, it can possibly cause delays or rejection in payments.

How often does CAQH need to be attested?

Upon expiration or termination of these Terms of Service, this license shall automatically terminate with respect to the applicable Service without further action on either Your or CAQHs part.

What happens if you dont attest on CAQH?

If you miss the window to re-attest with CAQH, your information will no longer be accessible to the health plans or other organizations youve authorized to access your profile, which can lead to re-credentialing delays and denials, or rejected claims.

What is an authorization and release form?

A HIPAA authorization form, also known as a HIPAA release form, is a document that individuals sign for their health provider before the entity may use or disclose their protected health information (PHI). HIPAA authorizes the sharing of PHI for the following purposes: Treatment. Payment. Healthcare Operations.

What is the standard authorization attestation release?

The Standard Authorization Attestation And Release is a document that grants permission for an organization to disclose or use certain information, typically related to services or authorizations provided.

What happens if I dont renew CAQH?

This database is used by most insurance payors for medical credentialing you into their network. If you dont keep all of the information in your CAQH profile current and also dont re-attest the validity of this information by the attestation expiration date; the payers could stop paying your claims.

What happens if you dont re-attest CAQH?

If providers do not attest within the required timeframe, their CAQH Provider Data Portal status will be changed to Expired.

Standard Authorization, Attestation and Release 2025

Here's how it works

How to quickly redact Standard Authorization, Attestation and Release online