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New Medicare Beneficiary Identification Rollout

Medicare
in Medicare

What You Need to Know

We are more than a month into the roll out of the new Medicare Beneficiary Identifier (MBI) changes, but some providers and staff (and even the beneficiary) may still have questions about this process. The information provided here should help answer any lingering questions. We will address the following: Who, What, When, Why and How.

Who?

This will be Medicare, or the Centers for Medicare & Medicaid Services (CMS), as they are the entity making the change. Also, the beneficiary and the provider, as they will be the entities affected.

What?

This is the removal of the beneficiary’s Social Security Number (SSN) and replacing it with a randomly generated ID number on their beneficiary ID cards. The new MBI is noticeably different than the SSN Identifier (also known as Health Insurance Claim Number (HICN)). You will see that the new MBI numbers will contain dashes, just as the SSN (or HICN), on the actual member cards. The dashes do not need to be entered on the claim form or anywhere else. These are shown only on the members card for illustration. The MBI must be kept confidential as it is considered protected Personally Identifiable Information (PII).

New Medicare Cards

When?

The roll out process began in April 2018 and is projected to continue until December 31, 2019. The chart below reflects each scheduled roll out for this process by state.

Wave

States Included

Cards Mailing

New Eligible People with Medicare

All - Nationwide

April 2018 - ongoing

1

Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia

Beginning May 2018

2

Alaska, American Samoa, California, Guam, Hawaii, Northern Mariana Islands, Oregon

Beginning May 2018

3

Arkansas, Illinois, Indiana, Iowa, Kansas, Minnesota, Nebraska, North Dakota, Oklahoma, South Dakota, Wisconsin

After June 2018

4

Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont

After June 2018

5

Alabama, Florida, Georgia, North Carolina, South Carolina

After June 2018

6

Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Texas, Utah, Washington, Wyoming

After June 2018

7

Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Puerto Rico, Tennessee, Virgin Islands

After June 2018


This process will happen in waves, as shown above, and continue through December 31st, 2019 unless otherwise indicated by CMS that additional time is needed.

Why?

The Medicare Access and CHIP Reauthorization Act of 2015 (also known as MACRA), is a bipartisan legislation signed into law on April 16, 2015, and implementation has resulted in many changes. We have already experienced a portion of this with the conversion of EHR & PQRS to MIPS in 2017. This conversion included creating the Quality Payment Program that repeals the Sustainable Growth Rate formula, and gives bonus payments for participation in eligible alternative payment models (APMs).

MACRA also requires the removal of SSNs from all Medicare cards. The new numbers will be randomly generated identifiers that will better protect the beneficiary’s identity. In removing the beneficiary’s SSN, the beneficiary’s private healthcare and financial information is better protected as well as the protection of federal health care benefits and payments.

How?

The new MBI will be used in the same way that the beneficiary’s SSN was used previously. The SSN appeared on the beneficiary’s ID card as well as on the claim forms and Remittance Notices. The MBI will populate the same fields on the claim forms or in your electronic health records that is indicated as the HICN. Likewise, on the EOB or ERA from Medicare, the HICN will now show the MBI instead of the patient’s SSN.

The beneficiary will not be issued a new effective date in this process. This date will remain the same and reflects the date that the beneficiary became a member with Medicare.

Some options for gathering this new information are as follows:

  • Upon arrival for care, request a copy of your Medicare patient’s new Medicare Card. If any patients have not received their new card, and it is after their states rollout date noted above, advise them to contact Medicare at 1-800-Medicare (1-800-633-4227)
  • Utilize Medicare Administrative Carrier (MAC)'s secure MBI look-up tool if the patient is unaware or unable to provide their MBI. Use the following tool to sign-up and begin using the tool. This tool will be available to use even after the December 31, 2019 scheduled completion date.
  • During this transition period, be in the habit of checking the remittance advice. Beginning October 2018, MBIs will be returned on all remittance advice when claims with valid and active Health Insurance Claim Numbers (HICNs) are submitted.

Making the Transition

There will be a “transition period” for this process. Providers and their offices will be able to use either the old number (HICN) or the new number (MBI), whichever is presented by the beneficiary, until December 31, 2019. This grace period will end on January 1, 2020, when it will be mandatory to use the new MBI number. Any claims with dates of service prior to the December 31, 2019 deadline, will have to be sent with the new MBI number if billed after January 1, 2020 to avoid being rejected.

Either identifying number (HICN or MBI) can be used to check the status of a claim only if the date(s) of service on the claim fall prior to the mandatory deadline of January 1, 2020. The new MBI number must be used on all claim queries containing dates of service beyond that date.

I’ve Been Rejected! Now What?

Any claims sent to MAC Carriers with the old number (HICN), will be rejected with both a Claim Adjustment Reason Code (CARC) and a Remittance Advice Remark Code (RARC). The CARC will be code 16 which will indicate: “Claim/service lacks information or has submission/billing error(s).” and the RARC code will be N382 which will indicate: “Missing/incomplete/invalid patient identifier.”

Should you receive a rejection, the claim may be resubmitted with the corrected number. For claims that you are appealing, either number will be accepted especially for dates of service prior to January 1, 2020. Appeals with a date of service after that, should reflect the new MBI number.

Beneficiaries of Railroad Medicare

Providers with beneficiaries of Railroad Medicare, should note that these individuals will also receive new MBI cards. You should follow up with the Railroad Retirement Board for how to proceed with new MBI numbers, as they may vary from those given for Original Medicare.

Additional Details

It is important to note that the beneficiary’s coverage with Medicare will not change or be interrupted with this roll-out and that they may use their new cards immediately upon receiving them.

The implementation of the new MBI numbers will NOT affect Medicare Advantage (Part C) Plans or the Prescription Drug (Part D) Plans. These plans will continue issuing their own identifying numbers to their members.

If a Medicare beneficiary believes that their card and identity has been compromised, for any reason, they are able to request a new card and the issuance of a new identity number. The number can also be changed at the discretion of CMS, should they determine that a beneficiary’s identity has been compromised. If this change occurs, the old number can be used on any claims submitted with a date of service prior to the change of the new identifier. Beyond that date, the new number must be used.

For more details, review the original article in its entirety here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE18006.pdf

 

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