Appeals Forms - JD DME
- CMS-1696 - Appointment of Representative
- CMS 20031 - Transfer (Assignment) of Appeal Rights
- Documentation Checklists
Redetermination - (First level)
- CMS 20027 - Medicare Redetermination Request
- Medicare DME Redetermination Request [PDF]
Reconsideration - (Second level)
- CMS 20033 - Medicare Reconsideration Request
Administrative Law Judge (ALJ) Hearing - (Third level)
Medicare Appeals Council Review (Departmental Appeals Board (DAB)) - (Fourth level)
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Last Updated Thu, 25 Oct 2018 12:52:21 +0000