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ALJ/MAC Decision Database



The Medicare web page now includes Medicare forms that can be downloaded and used by beneficiaries and advocates when filing Medicare appeals. The Centers for Medicare and Medicaid Services (CMS) added the forms to the Medicare web page after years of requests by Medicare advocates.

To get to the forms, go to and then click on Medicare Basics. Then scroll down the list of topics and click on Medicare Appeals Forms. The forms are available in PDF format.

So far, the site includes the following forms:

  • Appointment of Representative Form

  • Request for Review of Part B Medicare Claim

  • Request for Reconsideration of Part A Health Insurance Benefits

  • Request for Part A Hearing by an Administrative Law Judge

The site also includes forms and instructions for Medicare+Choice Notices:

  • Notice of Denial of Medicare Coverage for Medicare+Choice Plans

  • Notice of Denial of Payment for Medicare+Choice Plans

Other forms to be added to the site in the future include:

  • Request for Hearing - Part B Medicare Claim

  • Request for Part B Medicare Hearing by an Administrative Law Judge


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