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MBI For Billiing Office and Providers

CMS removed Social Security Number (SSN)-based Health Insurance Claim Numbers (HICNs) from Medicare cards and are now using Medicare Beneficiary Identifiers (MBIs) for Medicare transactions like billing, eligibility status, and claim status. CMS worked closely with business partners:

Social Security Administration SSA
United States Rail Road Retirement board  RRB

Every person with Medicare has been assigned an MBI. The MBI is confidential like the SSN and should be protected as Personally Identifiable Information.

According to CMS Everyone MUST submit claims using MBIs, no matter what date of services was performed, with a few exceptions.

Medicare plan exceptions:

  • Appeals - People filing appeals can use either the HICN or the MBI for their appeals and related forms.
  • Adjustments - You can use the HICN indefinitely for some systems (Drug Data Processing, Risk Adjustment Processing, and Encounter Data) and for all records, not just adjustments.
    • Reports - We’re using the HICN on these reports until further notice:
      • Incoming to us (quality reporting, Disproportionate Share Hospital data requests, etc.).
      • Outgoing from us (Provider Statistical & Reimbursement Report, etc.)
  • Retrospective reporting - Plans can use the HICN when submitting data for older contract years for applicable systems (e.g., Health Plan Management System).

Fee-for-Service claim exceptions:

  • Appeals - You can use either the HICN or the MBI for claims, appeals and related forms.
  • Audits – You can use either the HICN or the MBI for audit purposes.
  • Claim status query - You can use either the HICN or the MBI to check the status of a claim (276 transactions) if the earliest date of service on the claim is before January 1, 2020. If you're checking the status of a claim with a date of service on or after January 1, 2020, you must use the MBI.
  • Span-date claims - You can use the HICN for 11X-Inpatient Hospital, 32X-Home Health (home health final claims & Request for Anticipated Payments (RAPs)), and 41X-Religious Non-Medical Health Care Institution claims if the “From Date” is before the end of the transition period (12/31/2019). You can submit claims received between April 1, 2018 and December 31, 2019 using either the HICN or the MBI.  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.
  • 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. But, we'll accept the HICN on incoming premium remittances.  (Part A premiums, Part B premiums, Part D income related monthly adjustment amounts, etc.).

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