By Kim Turner, RN
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was required CMS to remove social security numbers (SSNs) from all Medicare cards by April 2019. CMS replaced the SSN-based HICN with a new, randomly generated MBI. The new Medicare Beneficiary Identifier (MBI) is noticeably different than the HICN.
On August 19, 2019 CMS reissued the MLN Matters article SE18006 to show that all new Medicare cards have been mailed, to encourage providers to use the Medicare Beneficiary Identifier (MBI) now to protect patients’ identities, to emphasize that providers must use MBIs beginning January 1, 2020, and to explain the rejection codes providers will get if they submit a HICN after January 1, 2020.
Use MBIs now for all Medicare transactions. Here are some tips to make sure that your staff is ready:
1. Ask your Medicare patients.
- Ask your Medicare patients for their new Medicare cards when they come for care.
2. Use your MAC's secure MBI look-up tool.
- You can look up MBIs for your Medicare patients when they don’t or can’t give them. Click the hyperlink below to sign up for the Portal and to use the MBI look-up tool.
Tip: If the look-up tool returns a last name matching error and the beneficiary’s last name includes a suffix, such as Jr. Sr. or III, try searching without and with the suffix as part of the last name.
3. Check the remittance advice.
- CMS will return the MBI on every remittance advice when you submit claims with valid and active HICNs through December 31, 2019. Get the MBI from the remittance advice and save it in your systems to use with your next Medicare transaction.
What are the exceptions for not using the MBI?
Starting January 1, 2020, even for services provided before this date, you must use MBIs. Otherwise, Medicare will reject claims you submit with Health Insurance Claim Numbers (HICNs.). Medicare will reject all eligibility transactions you submit with HICNs however there are a few exceptions when you can use either the HICN or MBI on or after January 1, 2020:
• Appeals – You can use either HICNs or MBIs for claim appeals and related forms.
• Claim status query – You can use the HICN or MBI to check the status of a claim (276 transactions) if the earliest date of service on the claim is before January 1, 2020. If you are checking the status of a claim with a date of service on or after January 1, 2020, you must use the MBI.
• Span-date claims – You can use HICNs or MBIs for 11X-Inpatient Hospital, 32X- Home Health (home health claims and Request for Anticipated Payments [RAPs]) and 41X-Religious Non-Medical Health Care Institution claims if the “From Date” is before the end of the transition period (December 31, 2019). If a patient starts getting services in an inpatient hospital, home health, or religious non-medical health care institution before December 31, 2019, but stops getting those services after December 31, 2019, you may submit a claim using either the HICN or the MBI, even if you submit it after December 31, 2019. Since you submit home health claims for a 60-day payment episode, you can send in the episode’s RAP with either the HICN or the MBI, but after the transition period ends on December 31, 2019, you have to use the MBI when you send in the final claim that goes with it.
Use the MBI the same way you used the HICN. Put the MBI in the same field where you’ve always put the HICN. This also applies to reporting informational only and no-pay claims. Don’t use hyphens or spaces with the MBI to avoid rejection of your claim. The MBI replaces the HICN on Medicare transactions including Billing, Eligibility Status, and Claim Status. The effective date of the MBI, like the old HICN, is the date each beneficiary was or is eligible for Medicare.
What about Medicare Advantage and Prescription Drug?
Medicare Advantage and Prescription Drug plans continue to assign and use their own identifiers on their health insurance cards. For patients in these plans, continue to ask for and use the plans’ health insurance cards.
Need help or have questions?
The van Halem Group's expert consultants are available to help answer your questions about using the MBI’s. Contact us today for more information about our services.