Copyright © 2014. maps®  Lien Resolution Services, LLC

LRS Referral Form
To be completed to furnish required claimant information to submit the case to maps®LRS.
Proof of Representation
To be completed by claimant. Allows Medicare/Contractors permission to discuss the case with maps
HIPAA Release
To be completed by claimant. Allows all non-Medicare entities permission to discuss the case with maps®LRS.
Final Settlement Detail Document
To be submitted with case settlement details to obtain the Final Demand Amount.

FOR AN INITIAL QUOTE:Please contact 504.831.2141 or 800.443.7351 or fill out the form below and someone will contact you shortly.

If mailing these or medical records, please send to:

Two Lakeway Center
3850 North Causeway Blvd Suite 400
Metairie, LA 70002
Direct Line: 504.831.2141 • 800.443.7351
Fax: 504.837.2566 • 800.878.5080



Option 1: Call 504.831.2141 or 800.443.7351 and speak with a case administrator

Option 2: Fax Referral Form to 504.837.2566 or 800.878.5080

​Option 3: Email Referral Form to