Appeals Forms - JA DME
Appeal Forms
General
- CMS-1696
- Appointment of Representative
- CMS 20031
- Documentation Checklists
Redetermination - (First level)
- CMS 20027
- Medicare DME Redetermination Request [PDF]
Reconsideration - (Second level)
- CMS 20033
Administrative Law Judge (ALJ) Hearing - (Third level)
Medicare Appeals Council Review (Departmental Appeals Board (DAB)) - (Fourth level)
Form Assistance
PDF File Downloading Technical Assistance
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Interactive Form Tips
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