Medicare Beneficiary Identifier Required in 2020
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 ) 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)

Related Topics:

Medicare Fraud Expert Witness

Medical Billing Expert Witness

Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. He leads a team that provides Cybersecurity best practices for healthcare clients, ICD-10 Consulting, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, Insurance Fraud, payor-provider disputes, and consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been quoted in the Wall Street Journal, New York Times, and National Public Radio.

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