Providio MediSolutions provides a broad spectrum of Medicare Secondary Payer Act (MSPA) compliance solutions for law firms, defendant insurers, third party administrators, self-insureds and, of course, Medicare beneficiaries themselves. We are uniquely positioned to provide value to clients by offering a variety of tools to help navigate the uncertain waters of MSPA compliance.
Lien Resolution Forms
For lien resolution referrals, you must complete (1) the Referral Intake Form (either online or download to fill out and submit), (2) the Providio Lien Counsel HIPAA Release, and (3) the Providio Lien Counsel Fee Agreement. If you are requesting lien services in connection with a Medicare lien, then you must also complete the Proof of Representation form.
Microsoft® Word Version
Lien Referral Intake Form
Providio Lien Counsel HIPAA Release
Providio Lien Counsel Fee Agreement
Proof of Representation (only for Medicare liens)
PDF Version
Lien Referral Intake Form
Providio Lien Counsel HIPAA Release
Providio Lien Counsel Fee Agreement
Proof of Representation (only for Medicare liens)