Explanation For The Required Change

EXPLANATION FOR THE REQUIRED CHANGE

Several of our customers (e.g. Arkansas State Hospital, etc.) have contacted CMS stating that they need a Spanish translation of Form CMS -1696 – Appointment Of Representative.

We contacted Triple-S to see if perhaps they developed a Spanish translation of the CMS-1696 and found out that they did not. The reason they gave was that their beneficiaries visit the Social Security Field Offices (FOs) to obtain the form and ask for assistance to fill it out.

With the transfer of responsibility for the Medicare ALJ function from the Social Security Administration to the Department of Health and Human Services, SSA FOs will no longer serve as filing locations for Medicare claim appeals. In addition, callers who wish to file an appeal will no longer contact SSA to request the appropriate forms and obtain assistance with completing the various English versions of our forms. Therefore, we believe there is now a need to provide a Spanish translation of the CMS -1696.