Is an electronic signature legally valid?

Yes. Under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted, electronic signatures have the same legal effect as handwritten signatures provided intent, consent, attribution, and reliable record retention are present.

Do healthcare attestations require a BAA for eSigning?

If the eSignature vendor handles protected health information, a HIPAA Business Associate Agreement is required to document responsibilities and safeguards under HIPAA rules.

What signature authentication is recommended?

Use multi-factor authentication or organizational SSO for authorized signers. Strong authentication strengthens attribution and reduces audit questions about signer identity.

Can attachments be submitted electronically?

Yes. Attach supporting reconciliations and claims extracts as PDFs or CSVs. Ensure file names, dates, and preparer metadata are included for auditability.

How long must I retain signed attestations?

Follow federal and program rules: retain at least three years generally, and six years for HIPAA records (45 CFR §164.530(j)); some programs or states impose longer periods.

What if a payer questions the attestation?

Provide the signed document, supporting reconciliations, audit trail data (timestamps, signer authentication), and any internal review notes to expedite resolution and demonstrate good-faith compliance.

Electronic Signature
Templates
Healthcare
Healthcare BPCI Attestation

Healthcare BPCI Attestation

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

HEALTHCARE BPCI ATTESTATION

This attestation documents the patient's informed consent to participate in a Bundled Payments for Care Improvement (BPCI) arrangement and authorizes necessary disclosures of Protected Health Information (PHI) for program administration, quality measurement, and payment reconciliation. By signing below the patient certifies the accuracy of the information provided and consents to the terms set forth in this document.

Patient Information

Patient Full Legal Name

Date of Birth:

Gender:

Phone:

Address Emergency Contact

Relationship:

Phone:

Insurance Information

Primary Insurance Provider

Policy / ID #:

Group #:

Subscriber Name:

Clinical / Episode Details

Attending Provider / Surgeon

Facility:

Admission Date:

Episode Start Date:

Primary Diagnosis / Procedure

Medical History

Current Medications (include dosages) Allergies (include reaction) Prior Surgeries / Significant Conditions

Attestation and Certifications

By checking the boxes below and signing, I hereby attest and certify the following under penalty of applicable law:

I voluntarily consent to participate in the BPCI arrangement described above and understand that participation involves coordinated care and alternative payment methodologies intended to improve quality and manage costs. I understand that my health care providers and the facility will bill payers as appropriate; I remain responsible for copayments, coinsurance, and deductibles in accordance with my insurance coverage. I certify that the medical and insurance information provided on this form is true and complete to the best of my knowledge. I understand that I may withdraw this attestation at any time, and withdrawal will not affect my right to receive medically necessary care.

I authorize the disclosure of my protected health information (PHI) to entities participating in the BPCI arrangement for purposes of care coordination, quality measurement, payment reconciliation, and program evaluation. Such PHI may include medical records, billing and claims information, and outcome data. I acknowledge that this disclosure may be necessary to administer bundled payments and measure clinical outcomes.

I acknowledge receipt of the Privacy Notice and understand my rights under applicable privacy laws with respect to the use and disclosure of my PHI for BPCI purposes.

Authorization Period

This authorization is effective as of the episode start date and shall remain in effect until the authorization expiration date provided below or until revoked in writing by the patient, except to the extent that action has already been taken in reliance on this authorization.

Authorization Expiration Date:

If no expiration date entered, authorization will remain in effect for the standard program period:

Patient Acknowledgment

By signing below I acknowledge that I have had the opportunity to ask questions about BPCI participation, the use and disclosure of my PHI, and the financial obligations that may result from my care. I understand the benefits and risks of participating in a bundled payment arrangement and consent to the disclosures and uses described herein.

Patient Printed Name:

Signature:

Date:

If signed by a representative, Relationship to Patient:

What the Healthcare BPCI Attestation Is

A Healthcare BPCI Attestation documents a provider’s compliance with Bundled Payments for Care Improvement (BPCI) program terms, stating that clinical, financial, and reporting requirements were met for a specified performance period. It typically identifies the provider, the bundle or episode types, the reporting period, and an authorized signature attesting to accuracy and completeness for payers or program administrators.

Why this Attestation Matters for Providers

The attestation creates an auditable statement used by payers and CMS-aligned programs to confirm participation, validate claims, and support reconciliation. Accurate attestations reduce audit exposure, clarify payment adjustments, and help preserve eligibility for bundled payment incentives.

Who completes and relies on a BPCI Attestation

Typical participants include hospitals, physician group administrators, and third-party administrators who manage bundled payment performance and reporting.

Hospitals and health systems managing bundled-care episodes and reconciliation
Physician groups and ACOs documenting episode participation and outcomes
Third-party administrators or consultants submitting attestations on behalf of providers

Payers, program administrators, and internal compliance teams use the signed attestation to reconcile payments and to support audits or program reviews.

Primary signers and their roles

Signing Official

Chief medical officer, CEO, or authorized executive who legally attests on behalf of the provider. They confirm that supporting records are accurate and that the attestation reflects institutional policies and internal validation procedures.

Compliance Officer

The compliance or quality officer reviews the underlying data and signs or co-signs where required. They document internal controls, data sources, and the review process used to verify the attestation.

Core parts of a professional BPCI Attestation

A complete attestation combines identification, program specifics, declaratory statements, supporting documentation, signature authority, and metadata for auditability.

Provider Identity

Legal entity name, NPI(s), tax identification or CMS provider number as applicable; precise identifiers avoid mismatches during payer processing and audits.

Program Details

Bundle name or episode type, start and end dates for the reporting period, and the payer or program contract ID to clearly locate the attestation in program records.

Attestation Statements

Clear declarative language specifying what is being attested (data accuracy, compliance with clinical protocols, cost reporting), with any material qualifications spelled out.

Supporting Documents

List and attach reconciliations, claims extracts, clinical summaries, and any audit logs referenced; include file names and dates for traceability.

Signature Block

Authorized signer name, title, signature, and execution date; include printed name and contact information to support verification requests.

Audit Metadata

Timestamps, signer IP or authentication method, and an audit trail entry that documents who prepared, reviewed, and submitted the attestation.

Step-by-step: completing a Healthcare BPCI Attestation

Follow these steps in sequence to prepare, verify, sign, and retain a complete attestation that supports payer reconciliation and audit readiness.

01

Gather data: Collect claims, clinical summaries, and reconciliation reports used to support the attestation.
02

Draft attestation: Populate the template with provider identifiers and the required declaratory language.
03

Internal review: Compliance and finance review the attestation and attachments for accuracy and completeness.
04

Sign and submit: Authorize with an accepted signature method and route to the payer or program portal per instructions.

Online configuration checklist for streamlined completion

Configure the digital template and routing to reduce clicks and ensure required fields are completed before signature.

Field	Configuration
Template	Lock mandatory fields to prevent accidental edits
Conditional Fields	Show attachments request only when specific boxes are checked
Authentication	Require two-factor or organization SSO for signers
Routing Order	Enforce signer order: preparer → reviewer → authorized signer

Where to send completed attestations

Send the signed attestation to the payer or program administrator according to the contractual submission method, with copies for internal retention.

Payer Portal: Upload per payer instructions
Program Admin: Submit to designated program contact
Internal Records: Store signed copy in compliance archive
Audit Package: Bundle supporting documents for audits

Technical considerations for digital signing and eSubmission

Ensure the signing platform supports required authentication, audit trails, and secure storage to meet payer and legal expectations.

Authentication: Email, SMS, or SSO
Integrations: Salesforce, NetSuite, Google Workspace
Formats: PDF, DOCX export

eSignature vendor snapshot for Healthcare attestations

Compare basic pricing and capabilities relevant to healthcare attestations. signNow is listed first per vendor comparison conventions; plan features and compliance differ by provider.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by plan	Varies by plan	Trial available	Trial available
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Required information elements at a glance

Provider ID: CMS number

NPI: National Provider Identifier

TIN: Tax identification number

Reporting Dates: MM/DD/YYYY range

Attestation Text: Required declaratory statement

Signature Info: Signer name, title, date

Common mistakes when preparing a BPCI Attestation

Using shorthand or DBAs instead of the legal entity name, which leads to mismatches during payer verification and delays.
Failing to attach reconciliations or claims extracts referenced in the attestation, creating gaps during audits and inquiries.
Allowing unsigned or partially completed fields to be submitted, which can invalidate the attestation or trigger rework.
Using weak signer authentication, increasing the likelihood of contested signatures and audit challenges.

Consequences of incorrect or false attestations

False Claims Liability: Civil liability under False Claims Act (31 U.S.C. §3729) for knowingly false attestations

Civil Monetary Penalties: Monetary fines and repayment obligations for improper payments

Program Exclusion: Potential OIG exclusion from federal healthcare programs (42 U.S.C. §1320a‑7)

Contract Remedies: Payer contract termination or clawback of incentives

HIPAA Risk: Breach exposures if protected health information is mishandled

Reputational Harm: Loss of payer trust and downstream business impact

Timing considerations and submission windows

Adhere to payer and program schedules for attestations, reconciliation, and reporting to avoid penalties or delayed payments.

Enrollment Window:

Submit attestations within the contractually defined enrollment or reconciliation window

Quarterly Reporting:

Follow payer schedules for regular reconciliation and reporting

Annual Reconciliation:

Complete yearly financial reconciliation per program rules

Immediate Notifications:

Report material adverse events as required by contract

Retention Start:

Retention begins on document creation or execution date

Key milestones in the attestation lifecycle

These sequential stages show what must happen from preparation through post-submission retention for a compliant attestation.

01

Prepare Documentation

Assemble claims, reconciliation, and clinical support files before drafting

02

Internal Review

Compliance and finance validate data and reconcile differences

03

Sign and Submit

Authorized signer executes the attestation and it is sent to the payer

04

Archive and Audit

Store signed copies and supporting records for required retention

Real-world examples of digital signing in healthcare workflows

These customer examples show how electronic workflows have been used to support healthcare document execution and compliance.

Fertility Centers of Illinois

A healthcare provider migrated attestations online to streamline approvals and retention.

The API enabled integration with back-office systems.
John Butler, Founder, praised the platform’s responsiveness and integration capabilities, noting improved workflow and audit readiness without sacrificing security.

Tech Data

An enterprise improved signature turnaround across departments using standardized templates.

Bulk and templated sends reduced manual routing.
Bob Dutkowsky, CEO, reported improved internal and external service while accelerating revenue recognition through faster document execution.

FAQs and troubleshooting for Healthcare BPCI Attestations

Answers to common questions about e-signatures, legal validity, attachments, and recordkeeping when preparing BPCI attestations.

Need help? Contact support

Is an electronic signature legally valid?
Yes. Under the ESIGN Act (15 U.S.C. §7001) and UETA where adopted, electronic signatures have the same legal effect as handwritten signatures provided intent, consent, attribution, and reliable record retention are present.
Do healthcare attestations require a BAA for eSigning?
If the eSignature vendor handles protected health information, a HIPAA Business Associate Agreement is required to document responsibilities and safeguards under HIPAA rules.
What signature authentication is recommended?
Use multi-factor authentication or organizational SSO for authorized signers. Strong authentication strengthens attribution and reduces audit questions about signer identity.
Can attachments be submitted electronically?
Yes. Attach supporting reconciliations and claims extracts as PDFs or CSVs. Ensure file names, dates, and preparer metadata are included for auditability.
How long must I retain signed attestations?
Follow federal and program rules: retain at least three years generally, and six years for HIPAA records (45 CFR §164.530(j)); some programs or states impose longer periods.
What if a payer questions the attestation?
Provide the signed document, supporting reconciliations, audit trail data (timestamps, signer authentication), and any internal review notes to expedite resolution and demonstrate good-faith compliance.

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