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Download Forms
All cases require a Client Intake Form and correct authorization.
Medicare Files:
Client Intake Form
Medicare Authorization
Non-Medicare Files (Medicaid, Private Insurance, ERISA):
Client Intake Form
HIPAA Authorizations
If your submission includes both Medicare and non-Medicare please include both authorizations
Phone: 248.850.7119
Fax: 877.294.7893
Toll Free: 844-MED-LIEN
 
25657 Southfield Road
Southfield, MI 48075
 
Email: info@mymedlien.com
 
 
 
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