Medicare Beneficiary Identifiers

What new Medicare Beneficiary Identifiers mean for you

MBIs are required for all claims and transactions starting Jan. 1, 2020 (with few exceptions).

Out with the old Health Insurance Claim Numbers (HICNs) and in with the new Medicare Beneficiary Identifiers (MBIs) as beneficiaries receive updated cards in advance of a Jan. 1, 2020, transition.

As of Aug. 19, the Centers for Medicare & Medicaid Services (CMS) had issued all-new Medicare cards, complete with MBIs, and encouraged providers to begin using the reconfigured, confidential identifiers for Medicare business, including claims submission and eligibility transactions. Although HICNs are still acceptable for use until the transition period ends, Dec. 31, 2019, MBIs are required for all claims and transactions starting Jan. 1, 2020 (with few exceptions), including those services provided prior to this date.

The change comes several years after the Medicare Access and CHIP Reauthorization Act required CMS to remove beneficiaries' Social Security Numbers (SSNs) from all Medicare cards in a move toward protecting personally identifiable information. The new, randomly generated MBIs are noticeably different than HICNs, featuring an alphanumeric identifier, but are used in a similar manner.

Per CMS guidance, providers will enter MBIs in the same field where HICNs have typically gone (minus hyphens or spaces to avoid claim rejection) and will replace HICNs on Medicare transactions, including Billing, Eligibility Status and Claim Status. The effective date of the MBI-like the old HICN-is the date each beneficiary was/is eligible for Medicare.

Should Medicare patients be unable to provide their MBI, providers can sign up for the portal and search based on patients' SSNs. If patients are unwilling to provide their SSN, providers may suggest they visit mymedicare.gov to get their MBI. Alternatively, providers will find patients' MBI on the remittance advice for claims with a valid and active HICN.

Although MBIs take effect Jan. 1, 2020, Medicare notes several exceptions where HICNs will still be acceptable, including:

Medicare plan exceptions

  • Appeals — May use either HICNs or MBIs for appeals and related documents.

  • Adjustments — May use HICN indefinitely for some systems (Drug Data Processing, Risk Adjustment Processing, and Encounter Data) and for all records.

  • Reports — Must use HICN on incoming reports (quality reporting, etc.) and outgoing reports (Provider Statistical & Reimbursement Report, Accountable Care Organization reports, etc.) until further notice.

Fee-for-Service claim exceptions

  • Appeals — May use either HICNs or MBIs for claims, appeals and related forms.

  • Audits — May use either HICNs or MBIs for audit purposes.

  • Claim status query — May use either HICNs or MBIs to check claim status if the earliest date of service on the claim is before Jan. 1, 2020. If you're checking the status of a claim with a date of service on or after Jan. 1, 2020, you must use the MBI.

  • Span-date claims — May use HICNs for Inpatient Hospital, Home Health, and Religious Non-Medical Health Care Institution claims if the "From Date" is before the end of the transition period (Dec. 31, 2019). If a patient starts these services prior to Dec. 31, 2019, but stops those services after Dec. 31, 2019, you may submit a claim with either HICN or MBI.

  • Incoming premium payments — People with Medicare who don't get SSA or RRB benefits and submit premium payments should use the MBI on incoming premium remittances. However, CMS will accept the HICN on incoming premium remittances after the transition period.

The CMS notes it will monitor volume of MBI usage and will ensure the transition from HICN won't inhibit normal operations. Click here to access CMS' frequently asked questions regarding MBIs.

August 26, 2019

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