Article Detail - JA DME

Effective January 1, 2020, the Medicare Beneficiary Identifier (MBI) will be required for all transactions submitted to Medicare including the following transactions (not all inclusive):

• Claim Submission: electronic and paper claim submissions for all dates of service
  • Note: Electronic claims received at CEDI after 5:00 PM ET on 12/31/2019, will be considered to have been received on January 2, 2020.
• Reopening requests for all dates of service
• Prior Authorization requests
• Advance Determination of Medicare Coverage (ADMC) requests
• Beneficiary information inquiries: written inquiries or self-service options including the following:
  • Beneficiary eligibility, deductible, Medicare Advantage Plan, Home Health and MSP information
  • Skilled Nursing Facility (SNF)/Inpatient Hospital Stay
  • Hospice Information
  • Certificate of Medical Necessity (CMN) Status
  • Diabetic Supplies and Diabetic Shoes Information
  • Competitive Bidding Area (CBA) Information
  • Claims history search
• General inquiries and written correspondence

Noridian encourages suppliers to use the MBI for all workloads. However, there are a few exceptions when the HICN may be utilized after January 1, 2020, if the MBI is unavailable:

• Appeals - Suppliers should use the MBI if available but are allowed to use HICNs for claim appeals and related forms when the MBI is unavailable.
• Claim status query - Suppliers should use the MBI if available but are allowed to use the HICN to check the status of a claim (276 transactions, or within the IVR or portal) if the earliest FROM date of service on the claim is before January 1, 2020. If you are checking the status of a claim where all dates of service are on or after January 1, 2020, you must use the MBI.

As the transition period comes to a close, be sure to keep up with the latest information. Click here for all things MBI!