Medicare Eligibility Form

New Assignment Form

Authorization to Release Information

Conditional Payment Authorization

SSDI Release (SSA Form 3288)

• Determine whether a Medicare Set-Aside and CMS approval are required
• Determine if reimbursement is due CMS for prior conditional payments
• Determine life expectancy of worker and substandard age rating if necessary
• Determine the amount of money needed to fund the Medicare Set-Aside
• Advise on the method of funding and administering the Medicare Set-Aside including any cost savings of funding with annuities
• Advise on wording of settlement documents
• Obtain CMS approval of proposed Medicare Set-Aside and settlement
• Coordinate annuity quotes and purchase

The Tenon Group® PLC provides Medicare Set-Aside services to workers' compensation attorneys, claims administrators, self-insureds, and insurers nationwide. We assist with any or all of the following, depending on the case. Our staff consists of highly experienced bodily injury claim professionals, personal injury attorneys, pharmacists, life care planners, and certified nurse case managers.

Tenon Group PLC • PO Box 959 • Union Lake, MI 48387 • Phone: 248.360.9952 • Fax: 248.360.6142