Appointment of Representative - JF Part B
Appointment of Representative
An appointed representative is a person authorized to act on behalf of a beneficiary or provider involved in the appeal. The appointed representative has all beneficiary or provider rights and responsibilities throughout the appeals process.
- To ensure an appointed representative is on file, a valid CMS Appointment of Representative form must be completed and submitted to Medicare. For completion assistance, see the Noridian Appointment of Representative Tutorial or Instructions
May be Appointed to Act as Representative
This is not all-inclusive.
- 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
- Physicians or suppliers
Providers or supplier employees are not required to include an Appointment of Representative (AOR) form
Required AOR Signatures and Timeliness Examples
- Representative must sign AOR form within 30 calendar days of party's signature
- Appointment of Representative form requires two dated signatures
- Signatures include: party to appeal and entity seeking to represent party to appeal
- Signature is valid one year from time of signing
- If signature dates are not the same, the latest date (must still be timely upon Noridian's receipt of appeal, to be considered valid) will determine the one-year timeliness
|Dates of Service
|Last Dated AOR Signature
|Date of Noridian Receipt
*Noridian will take into account holidays, weekends, and days the Noridian office is closed, which may impact receipt times.