Form CMS-10495 Attestation

Registration, Attestation, Dispute Resolution and Correction, Assumptions Document and Data Retention Requirements for Open Payments

Attestation Submission screen shots (starting on page 7)

AM and Applicable GPO (Attestation)

OMB: 0938-1237

Document [docx]
Download: docx | pdf

Screen Shots Submission Flow



The screen shots below illustrate the workflow (submission + Attestation) of a user uploading a file containing general payments records.

File Upload-General Payments





















Select criteria for file upload

Successful File Upload







Payments passed file level validation check and ready for FINAL Submission



Final Submission Button Enabled for final Submission



Final Submission Confirmation



Post Final Submission Confirmation



Begin Attestation



Attestation-Confirm Payments





Add Assumptions Yes/No?



Add Assumptions- Yes workflow





Assumptions Added





Agree To Attestation

Agree to Attestation_Cont

Agree to Attestation_Cont







Review and Attest



Review and Attest





Records shown as attested

Shape1



2


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorBirgach, Elmehdi
File Modified0000-00-00
File Created2021-01-27

© 2024 OMB.report | Privacy Policy