Can someone other than a Medicare beneficiary request a Medicare appeal on an unassigned claim FAQ

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Home ► FAQs ► Answers ► Can someone other than a Medicare beneficiary request a Medicare appeal on an unassigned claim FAQ

Last Modified: 4/4/2025 Location: FL, PR, USVI Business: Part B

Can someone other than a Medicare beneficiary request a Medicare appeal on an unassigned claim

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 external link

). 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.

Source: CMS IOM 100-4 Chapter 29 Section 270.1.1 external pdf file

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