Medicare Beneficiary Identifiers Accelerate Claim Payment

(4 min read) On January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) made the formal shift to the use of Medicare Beneficiary Identifiers (MBIs) in Medicare transactions. The change stems from provisions in the Medicare Access and CHIP Re-authorization Act of 2015 (MACRA) requiring CMS to remove social security numbers from all Medicare cards. The new randomly generated, 11-character patient identification numbers replace the social security number-based health insurance claim numbers (HICNs) previously used for Medicare patients. 

Physicians, providers, and suppliers are now required to use MBIs on Medicare eligibility transactions and claims, regardless of when healthcare services were rendered. Medicare will reject claims and transactions that fail to use MBIs, barring a few exceptions.

Exceptions include:

• Appeals: You can use either HICNs or MBIs for claim appeals and related forms. 
• Claim status queries: You can use HICNs or MBIs to check the status of a claim (276 transactions) if the earliest date of service on the claim was before January 1, 2020. 
• Span-date claims: You can use HICNs or MBIs if a patient starts getting services in an inpatient hospital, home health, or religious non-medical health care institution before December 31, 2019, even if you submit the claim after December 31, 2019. 

Outside of these exceptions, if you do not use MBIs on claims submitted in 2020 and going forward, you will get the following electronic claims rejection codes:

• A Claims Status Category Code of A7 (acknowledgment rejected for invalid information)
• A Claims Status Code of 164 (entity’s contract/member number)
• An Entity Code of IL (subscriber)

Paper claims that fail to use the MBI can anticipate the following rejection notices: 

• Claim Adjustment Reason Code (CARC) 16 “Claim/service lacks information or has submission/billing error(s)”
• Remittance Advice Remark Code (RARC) N382 “Missing/incomplete/invalid patient identifier”

Challenges in Managing the MBI Transition

With a reported 150 million MBIs being issued to active and archived Medicare beneficiaries, the scale of the change can have a dramatic impact on medical billing processes. Office staff can obtain Medicare patient MBI numbers by consulting patients’ re-issued Medicare cards, using the MBI lookup tool on your Medicare Administrative Contractor’s (MAC) website, or checking the remittance advice on claims submitted with a HICN between October 1, 2018, and December 31, 2019.

The challenge for billers – particularly those in the emergency medical space – is that patients often do not have their Medicare cards available and individual MBI lookups are time-consuming and put additional pressure on staff. 

You must have the patient’s social security number for lookups, which may differ from the HICN, which uses the social security number of the primary wage earner. Patients may be unwilling to release their social security number, at which point the patient must log in to mymedicare.gov to get the MBI, leading to delays for the healthcare billing team. Lookup tools are also prone to last name matching errors when the beneficiary’s last name includes a suffix. 

It is also important to note that hyphens or spaces in the MBI must be left out to avoid claim rejections. These hiccups can negatively impact office workflows and productivity and result in reimbursement delays.

Make the Transition to MBI Easier

The good news for ZOLL customers is that ZOLL has included new technology in its latest billing software updates to automatically lookup and convert MBIs quickly and securely.

ZOLL also offers a vendor-agnostic MBI batch lookup solution – available to any provider, current customer or otherwise – that runs a batch query for all Medicare patients in their database. All you need to do is submit a batch file in Excel format that includes each patient record and ZOLL will run our proprietary, enhanced MBI batch lookup tool and return the updated MBI numbers for all valid HICN and/or social security numbers submitted for your Medicare population – all within 24 hours. 

Your office could benefit from a batch MBI lookup solution. 

Complete our request form to have a representative show you how.

Top Tips for Finding and Using MBIs: 

• Find the MBI on the patient’s re-issued Medicare card
• Use the MBI lookup tool on your MAC website
• Use the auto-lookup feature available in your billing solution by ZOLL
• Take advantage of the vendor-agnostic ZOLL MBI batch lookup solution
• Use the MBI on Medicare transactions including billing, eligibility status, and claim status. The effective date of the MBI is the date each beneficiary was or is eligible for Medicare. 
• Ask the beneficiary or their authorized representative to request an MBI change if the MBI is compromised.
• Ask for and use Medicare Advantage and Prescription Drug plans health insurance cards. These plans continue to assign and use their identifiers.

Resources:

CMS MBI Overview

MBI format specifications (PDF)

MAC Provider Portals links