Providio encourages paperless communication and transactions wherever possible. Our online referral process is simple, safe and straight-forward. If you need assistance, please don't hesitate to contact us at 877.253.3120.

Step 1: Make an Online Referral

If you are ready to make a lien referral or a Medicare Set-Aside referral, there are several ways to get started. Click the links below to complete an online referral.

Once completed, be sure to download and sign the other relevant releases listed for liens and/or MSAs in the box to the right called "Step 2: Downloadable Forms & Releases."

If you prefer to download the referral form(s) rather than use an online form, please proceed to Step 2.

Online Lien Referral Form Online MSA Referral Form

Step 2: Downloadable Forms & Releases

This section contains releases/forms we need from you (in addition to the online form you just completed) in order to deliver lien negotiation and/or Medicare Set-Aside services. Please download and complete the appropriate forms for your case.

When you are ready to submit these forms back to Providio, you can email them to intake@providiomsa.com. If you prefer to fax the forms, please fax them to Providio at 866.862.3628. Be sure to include a fax subject line entitled "referral."

Download Lien Referral Forms Download MSA Referral Forms