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Please select the appropriate referral form
Submit a Conditional Payment referral when:
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The claimant is a Medicare beneficiary.
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If you don’t know, let Flagship determine that for you.
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The Claim involves a personal injury.
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Settlement negotiations on a Workers’ Compensation or Liability claim involving a bodily injury have commenced or will likely commence within 6 months.
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Money has or will change hands.
Submit a Medicare Set Aside referral when:
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The claimant is a Medicare beneficiary.
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If you don’t know, let Flagship determine that for you.
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There is a reasonable expectation the claimant will become a Medicare beneficiary within 30 months.
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The settlement will limit or terminate on-going responsibility for medical care in the future.
SUBMIT A REFERRAL
upload files for existing referrals
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