Rising Medical Solutions
325 N LaSalle St, Ste 600
Chicago, IL 60654
Tel: 877.672.4404 / Fax: 877.259.7473
Email: medadmin@risingms.com
 
REQUIRED FIELDS are denoted with an asterisk(*)

Medical Fund Administration Services Request
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Medical Fund Administration Services Request

* Service Requested:
Professional Administration-indicate what type(s):
Self Administration Support Service - Medicare Set-Aside Account (MSA)
Need assistance determining whether Professional Administration or Self Administration Support is needed.
 
Notes or Special Instructions
Case Status:
Has this claim been settled?  
Notes or Special Instructions