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Can someone other than a Medicare beneficiary request a Medicare appeal on an unassigned claim FAQ
Last Modified: 10/19/2022
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.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
