SUMBIT A REFERRAL

Need to submit a referral to Flagship Services Group? You've come to the right place!

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Please select the appropriate referral form

Submit a Conditional Payment referral when:

• The claimant is a Medicare beneficiary.

  • If you don’t know, let Flagship determine that for you.

• The Claim involves a personal injury.

  • Settlement negotiations on a Workers’ Compensation or Liability claim involving a bodily injury have commenced or will likely commence within 6 months.

• Money has or will change hands.

Submit a Medicare Set Aside referral when:

• The claimant is a Medicare beneficiary.

• If you don’t know, let Flagship determine that for you.

• There is a reasonable expectation the claimant will become a Medicare beneficiary within 30 months.

• The settlement will limit or terminate on-going responsibility for medical care in the future.

SUBMIT A REFERRAL

upload files for existing referrals