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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICESForm CMS1696 Approved OMB No. 09380950APPOINTMENT OF REPRESENTATIVE Name of Party Medicare Number (beneficiary as party)
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Fill out the PHP Medicare - AOR form accurately and completely.
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PHP Medicare - AOR stands for Provider Health Plan Medicare Advantage Organization Reporting.
Insurance companies offering Medicare Advantage plans and Medicare Advantage organizations are required to file PHP Medicare - AOR.
PHP Medicare - AOR can be filled out online through the CMS Health Plan Management System.
The purpose of PHP Medicare - AOR is to collect information on Medicare Advantage plans and organizations for regulatory purposes.
Information such as plan enrollment data, quality measures, and financial data must be reported on PHP Medicare - AOR.
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