Medicare will soon begin replacing beneficiaries’ social-security-based Health Insurance Claim Number (HICN) with new randomly-assigned Medicare Beneficiary Identifiers (MBI) to help protect against fraud and identity theft. Congress mandated the change through the Medicare Access and CHIP Reauthorization Act (MACRA) with an April 2019 deadline.
“We’re taking this step to protect our seniors from fraudulent use of Social Security numbers which can lead to identity theft and illegal use of Medicare benefits,” said CMS Administrator Seema Verma in a prepared statement. “We want to be sure that Medicare beneficiaries and healthcare providers know about these changes well in advance and have the information they need to make a seamless transition.”
CMS will begin mailing new Medicare cards with the MBI to beneficiaries in April 2018, at which time providers can use either the MBI or the SSI-based HICN to submit claims for existing members. However, provider systems must be updated and ready by April 2018 because new Medicare beneficiaries will receive only the MBI and not an HICN. Beginning in October 2018, CMS will return patients’ new MBI on every remittance advice for claims in which a member’s HICN was used. On electronic remittance advice transactions, the MBI will be in the same place you currently get the “changed HICN”: 835 Loop 2100, Segment NM1 (Corrected Patient/Insured Name), Field NM109 (Identification Code). After December 31, 2019, only the MBI will be accepted on claims.
Among the many benefits of using the MBI rather than the HICN is that CMS can terminate a Medicare ID number or issue a new one when needed, which wasn’t possible when using HICNs because of their connection to the member’s SSN.
On May 11, the AMA and 89 state and specialty medical societies sent a letter to CMS expressing concern over the transition to the MBI. Among their chief concerns was the lack of a contingency system that would allow providers to obtain a patient’s MBI if they arrived to an appointment without a new Medicare card. “This lack of a provider look-up system may strain a practice’s ability to conduct administrative transactions and delay patient care in the event that a patient does not present his or her card at the time of service,” the AMA said.
However, CMS has indicated that both providers and beneficiaries will be able to use secure look-up tools that will support quick access to MBIs when they need them.
CMS recommends providers take the following steps to prepare for the new Medicare cards and MBIs:
- Verify patients’ addresses. If the address you have on file is different than the Medicare address you get in electronic eligibility transaction responses, ask your patients to correct their address in Medicare’s records through Social Security.
- Ask your billing and office staff if your system will be ready to accept the 11 digit alpha numeric MBI. If you use vendors to bill Medicare, ask them about their MBI practice management system changes and make sure they are ready for the change. Make and internally test changes to your practice management systems and business processes by April 2018, before CMS mails the new Medicare cards.
- If you are a vendor who partners with Medicare providers to bill Medicare, communicate with them about your system readiness and what they should expect to see from you beginning April 2018.
In addition, be sure your system will be able to do the following as early as April 2018 and for sure by April 2019:
- Accept the new Medicare number.
- Identify patients who qualify for Medicare under the Railroad Retirement Board (RRB). (RRB patients will no longer be distinguished by the number on the new Medicare card. They will be identified by the RRB logo on their card. CMS also will return a message on the eligibility transaction response for a RRB patient. The message will say, “Railroad Retirement Medicare Beneficiary” in 271 Loop 2110C, Segment MSG. If you use the number only to identify your RRB patients beginning in April 2018, you must identify them differently to send Medicare claims to the RRB Specialty Medicare Administrative Contractor, Palmetto GBA.
- Update your practice management system’s patient numbers to automatically accept the new Medicare number or MBI from the remittance advice (835) transaction.
For more information about the new Medicare cards and MBIs, review the following resources:
- Transition to New Medicare Numbers and Cards Fact Sheet (ADDED 9.28,2017)
- CMS’s New Medicare Card Homepage
- Social Security Number Removal Initiative Reminder: Get Your Systems Ready
- New Medicare cards offer greater protection to more than 57.7 million Americans
- New Medicare Number: Prepare Your Systems for April 2018
- New Medicare Cards with New Numbers: 3 Changes You May Need to Make
- New Medicare Cards Offer Greater Protection to More Than 57.7 Million Americans
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