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New card, new Medicare MBI Standard in 2020

Medicare Beneficiary Identifier Required in 2020

The Medicare Beneficiary Identifier (MBI) is now required for all Medicare transactions.  In other words, for medical billing use of the MBI is essential. The Centers for Medicare & Medicaid Services (CMS) replaced the Social Security Number (SSN)-based Health Insurance Claim Numbers (HICNs) with the MBI and mailed new Medicare cards to all Medicare beneficiaries. The cards with MBIs offer better identity protection.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) required CMS to remove SSNs from all Medicare cards. CMS replaced the SSN-based HICN with a new, randomly generated MBI. The MBI hyphens on the card are for illustration purposes: don’t include the hyphens or spaces on transactions. The MBI uses numbers 0-9 and all uppercase letters except for S, L, O, I, B, and Z. We exclude these letters to avoid confusion when differentiating some letters and numbers (for example, between “0” and “O”). The MBI specifications format is available on the CMS website.

With a few exceptions, Medicare will reject claims that Medicare providers submit with Health Insurance Claim Numbers (HICNs). Medicare will reject all eligibility transactions you submit with HICNs.

There are three methods that providers can use to obtain Medicare Beneficiary Identifiers:

1. Ask the Medicare beneficiary for their Medicare card.

2. Use them according to Medicare Administrative Contractor (MAC) secure Medicare Beneficiary Identifier lookup tool.  Providers may look up MBIs for Medicare insureds when the beneficiary does not know their MBI. Medicare Advantage Plan beneficiaries are listed. The Social Security Number (SSN) is required to search for an MBI, and it may differ from the HICN, which uses the SSN of the primary wage earner.

3. Check the remittance advice – If a provider saw a patient and got a claim payment decision based on a claim submission with a HICN before January 1, 2020, the remittance advice also has the Medicare Beneficiary Identifier on every remittance advice when a provider submitted a claim with a

Medicare Beneficiary Identifier on new ID card
Comparison of new and old Medicare Card. The new card has the Medicare Beneficiary Identifier

valid and active HICN from October 1, 2018, through December 31, 2019.

There are a few exceptions regarding the use of the Medicare Beneficiary Identifier:

  • Appeals – Either HICNs or MBIs may be used for claim appeals and related forms.
  • Claim status query – a HICN or MBI may be used to check the status of a claim (These are also known as EDI 276 transactions) if the earliest date of service on the claim is before January 1, 2020. If a provider is checking the status of a claim with a date of service on or after January 1, 2020, the provider must use the MBI.
  • Span-date claims – You can use HICNs or Medicare Beneficiary Identifiers for 11X-Inpatient Hospital, 32X- Home Health (home health final 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, you may submit a claim using either the HICN or the MBI, even if you submit it after December 31, 2019.

How will the MBI look on the new card?

The MBI will contain letters and numbers. Here’s an example: 1EG4-TE5-MK73

  • 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. They won’t be entered into computer systems or used in file formats.
MBI Format for Medicare Beneficiary Identifier
Alpha-numeric pattern Standard for Medicare Beneficiary Identifier (MBI)

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Medicare Fraud Expert Witness

Medical Billing Expert Witness

Michael F. Arrigo

Michael Arrigo brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health IT, and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations who provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and medical billing, fraud damages, as well as electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, medical malpractice, insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software SA (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls IT audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and is published in Healthcare IT News.

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