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Organizational Chart / Ownership Attestation
Some payors require documentation showing who owns or manages your business. Here's how to submit a chart or attestation that meets credentialing requirements.
Some payors—especially Medicare, Medicaid, and larger commercial networks—require documentation that outlines who owns or controls your business. This can be submitted as a formal organizational chart, a simple ownership attestation, or both.
These documents help payors confirm that your group or facility is legitimate, compliant, and meets any disclosure requirements tied to ownership or control.
What Is an Organizational Chart?
An organizational chart is a simple diagram that shows how your practice is structured. For credentialing, it’s typically used to outline:
Charts are often structured like a tree—with the business entity at the top and the owners or key personnel shown below. If you're a solo owner, your chart can be very simple—and that’s perfectly acceptable.
What Is an Ownership Attestation?
An ownership attestation is a simple written statement confirming who owns the business and in what percentages. It may also list officers or managing members, especially if no formal chart exists.
Example language:
"ABC Therapy, PLLC is 100% owned and managed by Jane Smith, LCSW. She is the sole member and executive responsible for all clinical and operational decisions."
This is often sufficient for small private practices.
Why Do Payors Request This?
Credentialing and contracting teams use ownership documentation to:
Some payors also require this to comply with CMS ownership and control disclosure rules for organizations with 5%+ ownership interest.
When Is It Required?
You may be asked to submit this when:
Tips for a Smooth Submission
Need Help or Have a Question?
We know that credentialing doesn’t always follow a script. If something’s unclear or not covered here, reach out—we’re here to help.
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