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If you have Original Medicare, youll need to mail your claim form, itemized bill and supporting documents to the address for your state, which is listed on the Medicare Administrative Contractor Address Table within the claim form.
Submitting the necessary documents for Proof of Representation is a straightforward process. Your attorney may have the forms on hand, or you can download them from Medicare. You can submit and update any documents related to your case using the Medicare Secondary Payer Recovery Portal.
There are two ways to name an Authorized Representative: complete Form CMS-10106 and mail it to the listed address or provide authorization online through your Medicare Account. This authorization allows your chosen representative to contact Medicare about your eligibility, claims, payments to providers, and more.
A Consent to Release document is used by an individual or entity that does not represent the beneficiary but is requesting information regarding the beneficiarys conditional payment information.
You can submit a Beneficiary Consent to Release (CTR) authorization request to inform the Centers for Medicare Medicaid Services (CMS) that the Medicare beneficiary has given another individual or entity the authority to receive claims and other information related to the injury and/or illness but does not give this

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Consent to Release The beneficiary has authorized an individual or entity to receive certain information from the BCRC for a limited period of time. The release does not give the individual or entity the authority to act on behalf of the beneficiary.
Submit a written request to the QIC that includes: Your name, address, and the Medicare Number on your Medicare card [JPG]. List the specific items and/or services and dates youre filing a reconsideration about. You can also circle the items and/or services you wish to reconsider on a copy of your MSN.

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