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Can someone other than a Medicare beneficiary request a Medicare appeal on an unassigned claim FAQ
Last Modified: 7/9/2020
Location: FL, PR, USVI
Business: Part B
Q. Can someone other than a Medicare beneficiary request a Medicare appeal on an unassigned claim?
A. Under certain circumstances, yes. The beneficiary may complete an appointment of representative form (
CMS-1696 
). This form is used to authorize an individual to act as a beneficiary’s representative in connection with a Medicare appeal.
Although some parties may pursue a claim or an appeal on their own, others will rely upon the assistance and expertise of others. A representative may be appointed at any point in the appeals process. A representative may help the party during the processing of a claim or claims, and/or any subsequent appeal.
The following is a list of the types of individuals who could be appointed to act as representative for a party to an appeal. This list is not exhaustive and is meant for illustrative purposes only:
• Congressional staff members,
• Family members of a beneficiary,
• Friends or neighbors of a beneficiary,
• Member of a beneficiary advocacy group,
• Member of a provider or supplier advocacy group,
• Attorneys, and
• Physicians or suppliers.
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