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Rev. 12-11 MEDICAL SUBROGATION REFERRAL INJURY Region: From: To: Title: Date: Medical Subrogation 6021SW 29th Street Suite A, #373 Topeka, KS. 66614 Contact Person: Nikki Dillon Email: KSMEDSUB HMS.COM

How to fill out medical subrogation referral

How to fill out a medical subrogation referral:

1. Start by gathering all necessary information. This includes the patient's personal information, such as their name, address, and contact details, as well as their insurance information.
2. Ensure that you have the details of the healthcare provider or facility that provided the medical services. This includes their name, address, and contact information.
3. Determine the reason for the subrogation referral. This could be due to an accident or injury caused by a third party, for example.
4. Clearly state the details of the third party involved in the incident. This includes their name, address, and any relevant insurance information if available.
5. Provide a detailed description of the medical services or treatments provided to the patient. Include dates, diagnoses, procedures, and any other relevant information.
6. Attach any supporting documentation, such as medical records, bills, or invoices, that support the medical services provided to the patient.
7. Sign and date the referral form to confirm its authenticity and accuracy.
8. Submit the completed referral form along with any supporting documents to the appropriate parties, such as the insurance company or legal representative handling the subrogation claim.

Who needs a medical subrogation referral?

1. Individuals who have received medical treatment or services that were caused by a third party may need a medical subrogation referral.
2. Insurance companies may require a medical subrogation referral to pursue reimbursement from the responsible third party or their insurance company.
3. Legal representatives or attorneys who are handling a personal injury lawsuit on behalf of the injured party may also require a medical subrogation referral to support their case and seek compensation.

Note: It is important to consult with a legal professional or insurance expert for specific guidance and requirements related to medical subrogation referrals in your jurisdiction.

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What is medical subrogation referral?

Medical subrogation referral is a process in which an insurance company seeks reimbursement for medical expenses it has paid on behalf of its insured from a third-party that is responsible for the injuries or medical treatment.

Who is required to file medical subrogation referral?

The insurance company or the entity that has provided medical coverage to the insured is required to file a medical subrogation referral.

How to fill out medical subrogation referral?

To fill out a medical subrogation referral, the insurance company needs to gather all relevant medical billing and treatment records, identify the responsible third-party, and submit a formal request for reimbursement.

What is the purpose of medical subrogation referral?

The purpose of medical subrogation referral is to recover the costs of medical treatment that were paid for by the insurance company on behalf of the insured from the party responsible for the injuries or medical expenses.

What information must be reported on medical subrogation referral?

The medical subrogation referral must include details of the medical expenses paid, the medical treatment received, the date of the injury or treatment, and any relevant insurance or legal information.