Medicare Claims Processing Manual (Pub. 100-04), Ch. 29 § 270.2.4
When to Submit the Transfer of Appeal Rights
270.2.4 - When to Submit the Transfer of Appeal Rights
(Rev. 1274, Issued: 06-29-07, Effective: 07-01-07, Implementation: 10-01-07)
A provider or supplier may submit the completed transfer of appeal rights form to the MAC at the time he or
she submits an appeal request. The provider or supplier may obtain the completed transfer of appeal rights
form from the beneficiary at the time that the services are provided, and file the previously signed form with
the appeal.