Appoint a Representative
We are the Medicare Quality Improvement Organization, working to improve the quality of care for Medicare beneficiaries. Our site offers beneficiary and family-centered care information for providers, patients, and families. Welcome!
Any person you appoint, such as a family member or friend, may help you:
- Request a coverage determination or an appeal
- File a quality of care concern
You must first complete the “Appoint a Representative” form (Form Number 1696).
If you have questions about appointing a representative, call 1-800-MEDICARE (633-4227). TTY users should call 877-486-2048.
Download Acrobat Reader