Client Login:

  • DomesticAccess for U.S. TPAs, MGUs, Healthplans, Workers Compensation, etc.
  • InternationalAccess for Non-U.S. Assistance Companies, Insurers, Government Agencies, etc.
  • MaritimeAccess for P&I Clubs, Ship Owners, Cruise Lines, Vessels, etc.
  • PPO Access for National, Regional, Specialty Networks
  • ProvidersAccess for Providers and Hospitals serving Maritime and International Members.
  • ConsumersAccess for private pay individuals

Reporting Authorization Form

Please provide the information below to set up access to the Medicare Secondary Payor Reporting Services.

Authorized Representative:
Business Title:
Company Name:
Company TIN/EIN:
Address:
City:
Zip Code:
Phone Number:
Fax Number:
Email:
Account Manager:
Business Title:
Company NAIC Code:
Office Reporting Code:
RRE ID:
RRE Description: