To enroll or conduct a Benefits Review, please visit this site from your desktop computer.
Claim Documents
Office Support Tools
Patient Benefits Information Form
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Medically Unlikely Edit (MUE) Appeal Template Letter
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Medical Necessity Template Letter*
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Letter of Medical Necessity Checklist
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Prior Authorization Denial/Redetermination Appeal Template Letter*
Download
Commercial Claim Denial Appeal/Redetermination Template Letter*
Download
Open Access Template Letter*
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My BMS Cases User’s Guide
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HCP Reimbursement Process Map
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*Template letters are provided as examples of potential correspondence.
CMS Forms and Documents
Medicare Redetermination Request Form (Form CMS-20027)
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Medicare Reconsideration Request Form (Form CMS-20033)
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Request for a Medicare Hearing by an Administrative Law Judge (Form CMS-20034A/B)
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Medicare Appointment of Representative Form (Form CMS-1696)
Download
Patient Resources
Understanding Your Healthcare Benefits
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Patient Brochure
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Patient Reimbursement Process Map
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The accurate completion of reimbursement- or coverage-related documentation is the responsibility of the healthcare provider and patient. Bristol Myers Squibb and its agents make no guarantee regarding reimbursement for any service or item.