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Experience. Integrity. Advocacy.

What to Do if a Medicare Patient’s MBI Changes

What to Do if a Medicare Patient’s MBI Changes

Providers who receive an eligibility error code on their Medicare claims should check to see if the patient’s Medicare Beneficiary Identifier (MBI) has changed.

Beginning January 1, 2020, healthcare providers are required to submit the new MBIs, which replaced the old Social Security Number–based Health Insurance Claim Numbers (HICN), on all claims and correspondence. 

The new MBIs, which were mandated under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), allows the Centers for Medicare and Medicaid Services (CMS) to remove SSNs from all Medicare cards. Because the MBIs are intended to better protect patient identity, Medicare beneficiaries can ask to change their MBI in the event the number has been compromised. CMS also can initiate a change to the MBI. 

To determine if and when the MBI has changed, providers should perform a historic eligibility search, which will return a termination date of the old MBI. Then, providers can learn the new MBI by using their Medicare Administrative Contractor’s (MAC’s) secure MBI look-up tool on the MAC portal.

Once an MBI has been changed, providers can use the new MBI to look up any claims information or eligibility transactions for the Medicare beneficiary, both before and after the new number was issued. However, the old MBI will allow searches only on claims information and eligibility transactions with a date of service or “From Date,” in the case of date range, that occurred before the termination date.

For more information about how to get and use the new MBI, refer to MLN Matters: SE18006, which was just reissued on January 2, 2020.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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