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An authorized representative is an individual authorized under State or other applicable law to act on behalf of a beneficiary or other party involved in the appeal. Authorized representatives have all of the rights and responsibilities of a beneficiary or party, as applicable, throughout the appeals process.
Appointment of Authorized Representative Use this form to appoint an individual or organization as your Medi-Cal authorized representative. Your authorized representative may act for you on all duties related to your Medi-Cal eligibility and enrollment. Or, you may also limit duties.
To appoint a representative, you or your representative should complete the form entitled: Appointment of Representative - CMS-1696 - PDF.
Medicare beneficiaries have the right to choose someone to help make decisions about Medicare coverage. This is referred to as an Authorized Representative. This person is only authorized to help with Medicare joining a plan, quitting a plan, finding out information about insurance and handling claims and payments.
An authorized representative is an individual authorized under State or other applicable law to act on behalf of a beneficiary or other party involved in the appeal. Authorized representatives have all of the rights and responsibilities of a beneficiary or party, as applicable, throughout the appeals process.
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You can use the Appointment of Representative (AOR) form CMS-1696* or you can make your own statement (an equivalent written notice) as long as it contains all the required information. In addition, we may also accept other forms of legal documentation.
mandatary; attorney; deputy; proxy; authorized person; empowered person; authorized agent.
To name you as an Authorized Representative, your loved one must complete a form called the Medicare Authorization to Disclose Personal Health Information. If your loved one is unable to complete the form, you may do it as long as you have legal documentation giving you that right.
An appointed representative is a person who can act on your behalf to request an appeal or complaint. If you need someone to file a grievance, coverage determination, organization determination, or an appeal on your behalf, you can name a relative, friend, advocate, or anyone else as your appointed representative.
Yes. There is no limit to how many Authorized Representatives you can have, but you must submit a separate form for each person you appoint as an Authorized Representative. Can I have an organization act as my Authorized Representative?

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