To enroll or conduct a Benefits Review, please visit this site from your desktop computer.
Claim Documents
Office Support Tools
Alternative Funding Program (AFP) Appeal Template Letter
Download
Peer-to-Peer Medical Checklist
Download
Patient Benefits Information Form
Download
Medically Unlikely Edit (MUE) Appeal Template Letter
Download
Medical Necessity Template Letter*
Download
Letter of Medical Necessity Checklist
Download
Prior Authorization Denial/Redetermination Appeal Template Letter*
Download
Commercial Claim Denial Appeal/Redetermination Template Letter*
Download
Open Access Template Letter*
Download
My BMS Cases User’s Guide
Download
HCP Reimbursement Process Map
Download
A Guide to Medicare Part D
Download
A Guide to Electronic Benefits
Reverification (eBRV)
Download
Getting Started with BMS Access Support: An HCP Guide
Download
*Template letters are provided as examples of potential correspondence.
CMS Forms and Documents
Medicare Redetermination Request Form (Form CMS-20027)
Download
Medicare Reconsideration Request Form (Form CMS-20033)
Download
Request for a Medicare Hearing by an Administrative Law Judge (Form CMS-20034A/B)
Download
Medicare Appointment of Representative Form (Form CMS-1696)
Download
Patient Resources
Low-Income Subsidy Brochure
Download
Understanding Your Healthcare Benefits
Download
Patient Brochure
Download
Patient Reimbursement Process Map
Download
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.