Enrollment Forms
Oncology Enrollment Form
DownloadOncology Patient Authorization and Agreement Form (English)
DownloadOncology Patient Authorization and Agreement Form (Spanish)
DownloadTo enroll or conduct a Benefits Review, please visit this site from your desktop computer.
Claim Documents
Office Support Tools
Patient Benefits Information Form
DownloadMedically Unlikely Edit (MUE) Appeal Template Letter
DownloadOncology Infusion Checklist
DownloadMedical Necessity Template Letter*
DownloadLetter of Medical Necessity Checklist
DownloadPrior Authorization Denial/Redetermination Appeal Template Letter*
DownloadCommercial Claim Denial Appeal/Redetermination Template Letter*
DownloadOpen Access Template Letter*
DownloadMy BMS Cases User’s Guide
DownloadHCP Reimbursement Process Map
Download*Template letters are provided as examples of potential correspondence.
CMS Forms and Documents
Medicare Redetermination Request Form (Form CMS-20027)
DownloadMedicare Reconsideration Request Form (Form CMS-20033)
DownloadRequest for a Medicare Hearing by an Administrative Law Judge (Form CMS-20034A/B)
DownloadMedicare Appointment of Representative Form (Form CMS-1696)
DownloadPatient Resources
Enrollment Form
Kidney Transplant Enrollment Form
DownloadKidney Transplant Patient Authorization and Agreement Form
DownloadTo enroll or conduct a Benefits Review, please visit this site from your desktop computer.
Claim Documents
Office Support Tools
Patient Benefits Information Form
DownloadMedical Necessity Template Letter*
DownloadPrior Authorization Denial/Redetermination Appeal Template Letter*
DownloadCommercial Claim Denial Appeal/Redetermination Template Letter*
DownloadMy BMS Cases User’s Guide
Download*Template letters are provided as examples of potential correspondence.
CMS Forms and Documents
Medicare Redetermination Request Form (Form CMS-20027)
DownloadMedicare Reconsideration Request Form (Form CMS-20033)
DownloadRequest for a Medicare Hearing by an Administrative Law Judge (Form CMS-20034A/B)
DownloadMedicare Appointment of Representative Form (Form CMS-1696)
DownloadPatient Resources
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.