HIPAA Release Form: This form authorizes Marker 28 to submit Protected Health Information to CMS, according to HIPAA guidelines.
Marker 28 HIPAA
Beneficiary POR: This form authorizes Marker 28 to receive or submit information/requests on behalf of the beneficiary. For example: Conditional Payment Investigation. <download>
Marker 28 Beneficiary POR
LOA (Blank): Letter of Authorization, Proof of Representation Agent Agreement. This release allows Marker 28 to work on behalf of the insurer to reduce Conditional Payments. For example: Disputes and Appeals for Conditional Payments that are not related to the claim. <download>
Letter of Authority LOA Template
Marker 28 Referral Form: Download this form if you prefer to use it rather than the online form on Referrals page.
Marker 28 Referral Form