We will need either the WC Claim Form, Liability Intake form, or Case Management Referral Form for all referrals. For all Medicare Set-Aside (MSA) and Medical Cost Projection (MCP) referrals, we also need the following:
If you need the injured individual’s Medicare status, the signed SSA Release is required. If you need the MSA submitted to CMS, the signed Consent Form is required. Should you need to discuss the claim prior to making a referral, please do not hesitate to contact us.
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