To be completed by claimant. Allows Medicare/Contractors permission to discuss the case with maps Lien Resolution Services.
DownloadTo be completed by claimant. Allows all non-Medicare entities permission to discuss the case with maps Lien Resolution Services.
DownloadTo be submitted with case settlement details to obtain the Final Demand Amount.
DownloadTo be placed on your letterhead and submitted to us to establish authority with the CRC.
Download