--- title: Fill Out CMS-20031 Online | Transfer of Appeal Rights description: Complete CMS-20031 online, generate a finished PDF, and organize the transfer-of-appeal-rights form for the specific Medicare item or service being appealed. seotitle: Fill Out CMS-20031 Online | Transfer of Appeal Rights seo-description: Complete CMS-20031 online, generate a finished PDF, and organize the transfer-of-appeal-rights form for the specific Medicare item or service being appealed. group: resources indexable: true llms: true schema: webpage tags: - medicare - appeals - provider-authority path: /forms/cms-20031 --- # Fill Out CMS-20031 Online | Transfer of Appeal Rights Complete CMS-20031 online, generate a finished PDF, and organize the transfer-of-appeal-rights form for the specific Medicare item or service being appealed. ## How it works 1. **Fill out the form** - Complete the guided fields online. 2. **Add attachments** - Upload any required documents. 3. **Preview the PDF** - Review the final form before mailing. 4. **Mail it** - We print and mail the packet for you. ## Form summary CMS-20031 lets a Medicare beneficiary transfer appeal rights for one listed item or service to the provider or supplier that furnished it. ## What you need - Beneficiary name, Medicare number, and phone number - The specific item or service connected to the appeal - Provider or supplier contact details - Beneficiary signature and provider acceptance signature with dates - Signed form (wet signature required) - Supporting claim documents (optional) (optional) — Attach claim notices, denial letters, or medical documentation that supports the appeal transfer. ## Data collected - Beneficiary name, Medicare number, and phone number - The item or service being appealed - Provider or supplier contact details - Beneficiary and provider signatures with dates ## Where it gets mailed You will enter the recipient address during checkout. ## Packet order - Cover sheet (auto-generated) - Completed form PDF - Attachments (in the order you upload) ## Common mistakes - Treating the form as a blanket transfer for every Medicare claim instead of one listed item or service. - Listing a provider who did not furnish the item or service at issue. - Missing either the beneficiary signature or the provider acceptance signature. - Forgetting that the beneficiary can lose the right to appeal that item or service directly unless the transfer is canceled in writing. ## Agent summary This workflow collects the beneficiary and provider details needed to transfer Medicare appeal rights for one specific item or service. ## For assistants Use the Forms Draft API to prefill this form and generate a preview PDF. - Endpoint: `POST /api/forms/cms-20031/drafts` - Payload: `{ fields: { ... }, attachments: [{ id, label, base64 }] }` - Required fields: beneficiary_name, medicare_number, beneficiary_phone, provider_phone_in_transfer, provider_city_in_transfer, provider_state_in_transfer, provider_zip_in_transfer, item_or_service, patient_name_in_statement, provider_name_in_statement, patient_signature, patient_signature_date, provider_name_signature_block, provider_signature, provider_signature_date, provider_phone, provider_street_address, provider_city, provider_state, provider_zip - Attachment IDs: supporting_documents ## LLM field schema ```json [ { "id": "beneficiary_name", "label": "Name of Medicare beneficiary", "type": "text", "required": true, "meta_class": "name", "ui_width": null, "group_id": "beneficiary-info", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "medicare_number", "label": "Medicare number", "type": "text", "required": true, "meta_class": null, "ui_width": null, "group_id": "beneficiary-info", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "beneficiary_phone", "label": "Beneficiary phone number", "type": "text", "required": true, "meta_class": "phone", "ui_width": null, "group_id": "beneficiary-info", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "provider_phone_in_transfer", "label": "Provider/supplier phone number (transfer section)", "type": "text", "required": true, "meta_class": "phone", "ui_width": null, "group_id": "transfer-authorization", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "provider_city_in_transfer", "label": "Provider/supplier city (transfer section)", "type": "text", "required": true, "meta_class": "city", "ui_width": null, "group_id": "transfer-authorization", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "provider_state_in_transfer", "label": "Provider/supplier state (transfer section)", "type": "text", "required": true, "meta_class": "state", "ui_width": null, "group_id": "transfer-authorization", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "provider_zip_in_transfer", "label": "Provider/supplier ZIP code (transfer section)", "type": "text", "required": true, "meta_class": "zip", "ui_width": null, "group_id": "transfer-authorization", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "item_or_service", "label": "Item or service being appealed", "type": "text", "required": true, "meta_class": null, "ui_width": null, "group_id": "appeal-details", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "patient_name_in_statement", "label": "Patient name in transfer statement", "type": "text", "required": true, "meta_class": "name", "ui_width": null, "group_id": "transfer-authorization", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "provider_name_in_statement", "label": "Provider or supplier name in transfer statement", "type": "text", "required": true, "meta_class": "name", "ui_width": null, "group_id": "transfer-authorization", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "patient_signature", "label": "Patient signature", "type": "signature", "required": true, "meta_class": null, "ui_width": null, "group_id": "patient-signature", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "patient_signature_date", "label": "Date signed by patient", "type": "text", "required": true, "meta_class": "date", "ui_width": null, "group_id": "patient-signature", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "provider_name_signature_block", "label": "Provider name in acceptance statement", "type": "text", "required": true, "meta_class": "name", "ui_width": null, "group_id": "provider-acceptance", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "provider_signature", "label": "Provider/supplier signature", "type": "signature", "required": true, "meta_class": null, "ui_width": null, "group_id": "provider-acceptance", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "provider_signature_date", "label": "Date signed by provider", "type": "text", "required": true, "meta_class": "date", "ui_width": null, "group_id": "provider-acceptance", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "provider_phone", "label": "Provider/supplier phone number", "type": "text", "required": true, "meta_class": "phone", "ui_width": null, "group_id": "provider-acceptance", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "provider_street_address", "label": "Provider/supplier street address", "type": "text", "required": true, "meta_class": "address", "ui_width": null, "group_id": "provider-acceptance", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "provider_city", "label": "Provider/supplier city", "type": "text", "required": true, "meta_class": "city", "ui_width": null, "group_id": "provider-acceptance", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "provider_state", "label": "Provider/supplier state", "type": "text", "required": true, "meta_class": "state", "ui_width": null, "group_id": "provider-acceptance", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null }, { "id": "provider_zip", "label": "Provider/supplier ZIP code", "type": "text", "required": true, "meta_class": "zip", "ui_width": null, "group_id": "provider-acceptance", "choice_group": null, "choice_label": null, "visibility": null, "compound_subfields": null } ] ``` ## Sources - [CMS-20031 Transfer of Appeal Rights PDF](https://www.cms.gov/cms20031-transfer-appeal-rights) - [Medicare appeals overview](https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal) - [Official instructions](https://www.cms.gov/cms20031-transfer-appeal-rights) - [Official PDF](https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms20031.pdf) ## Last verified 2026-03-20 ## FAQs - **Does this transfer apply to all of my Medicare claims?** No. The transfer applies only to the specific item or service identified in this form. - **What happens after I transfer my appeal rights?** The provider or supplier may pursue the appeal with Medicare for the listed item or service, and you generally will not appeal that denial yourself. - **Can I cancel the transfer later?** Yes. You can cancel the transfer later in writing. ## Related - [CMS-20027 - Redetermination Request Form](/forms/cms-20027) - [CMS-20033 - Medicare Reconsideration Request](/forms/cms-20033) - [CMS-1490S](/forms/cms-1490s) - [CMS-20031 transfer of appeal rights guide](/health-insurance/cms-20031-transfer-of-appeal-rights-guide) - [CMS-20027 Medicare redetermination guide](/health-insurance/cms-20027-medicare-redetermination-guide) - [Fill out official PDF forms online](/fill-out-official-pdf-forms-online)