The Transition Period is Over!

For 2020, it’s out with the old, and in with the new. Starting January 1st, 2020, CMS will reject any and all claims submitted with the old, the HICN (Health Insurance Claim Number), and will only accept them submitted with the new, the MBI (Medicare Beneficiary Identifier). Hopefully, you’ve been hearing about this change for some time and are already accustomed to submitting your data exchanges with the new MBI. If you’re not, here’s a couple of points you should definitely take note of going into the new year. 

MBIs are all unique and randomly generated. The numbers don’t correspond to any patient information, and the characters are all non-intelligent. 

MBIs: 

1. Are 11 characters in length, for example: 1EG4-TE5-MK72
   • The MBI’s 2nd, 5th, 8th, and 9th characters will always be a letter.
   • Characters 1, 4, 7, 10, and 11 will always be a number.
   • The 3rd and 6th characters will be a letter or a number.
   • The dashes aren’t used as part of the MBI.
   • Consist of only uppercase letters and numbers, excluding the letters S, L, O, I, B, and Z to eliminate confusion.
     • Learn more about MBI format specifications here. 
2. Are clearly different than the HICN and RRB (Railroad Retirement Board) numbers
   • If you submit a claim with an RRB number instead of an MBI, there should be an alert that is returned on the HETS eligibility transaction response. 
3. Should be protected by Medicare beneficiaries as though it was their Social Security Number

You will use MBIs going forward for all beneficiary issues regarding billing, eligibility status, and claim status. There are a few exceptions where you will still be able to use the HICN/MBI: 

1. Appeals & Adjustments
2. Retrospective Reporting
3. Fee-for-Service claim exceptions:
4. Appeals, Audits, Claim Status Query, Span-Date Claims, Incoming Premium Payments
5. Private payers submitting non-Medicare claims

All of your patients should have their new Medicare cards and MBIs already, but if they don’t, providers still have a way to help beneficiaries get their MBIs - using the secure web portal with MAC (Medicare Administrative Contractor).

1. Providers/Suppliers can use a MAC portal to look up any beneficiary’s MBI with the following information: 
   • Patient SSN, Last Name, First Name, and Date of Birth 

This transition may seem like a pain in addition to everything else that has to changeover for 2020, but the system will ultimately be beneficial in the long run. Removing Social Security Numbers from Medicare cards and systems helps to protect the 61 million beneficiaries across the United States from taxpayer fraud and identity theft. 

Contact us today if you still have questions. We want to help you succeed.