Medicare Compensation Recovery Notice of reimbursement arrangement form (MO027)

Use this form if you are a compensation payer or insurer and have accepted liability to reimburse a claimant for expenses as they are incurred.

This notice should be sent to us within 28 days.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

Page last updated: 14 December 2016

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