Medicare Beneficiary Identifier (MBI)
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number on new Medicare cards for transactions like billing, eligibility status, and claim status. Prepare for this change by visiting the new overview and provider webpages, which include:
- Transition period
- Characteristics of the MBI
- How to obtain the MBI
It's time for provider to look at their practice management systems and business processes and determine what changes must be made to use the new MBI.
Moving to new Medicare Numbers and cards requires many changes to systems and how business is done.
Noridian has already started this work and we want to help you shift to the new MBIs. Beginning in April 2018, in phases by geographic location (see schedule below), CMS starts mailing the new Medicare cards, containing the MBI, to all people with Medicare.
Providers may need to change their systems to accept the new MBI. If a vendor is used to bill claims to Medicare, be sure their systems are ready for the MBI. Providers should test system changes and work with their billing office staff to ensure all are prepared to use the new MBI format.
CMS is planning to test systems that will use the MBI, including enhanced integration testing (EIT) for new or high-risk systems. End-to-end testing with Medicare fee-for-service claims processing systems is not being offered as providers may use Health Insurance Claim Numbers (HICNs) or MBIs to submit claims during this transition period.
Providers can use the transition period as a live test and adjust as necessary, yet still have claims submitted and processed with HICNs until the transition period (begins no earlier than April 1, 2018 and runs through December 31, 2019) ends.
Transition Period: April 1, 2018 - December 31, 2019
During the transition period, Noridian will monitor the use of HICNs and MBIs to see how many providers are ready to use only MBIs by January 2020. We'll also actively monitor the transition and adjustment to the new MBIs to make sure of their wide-spread adoption so Medicare operations aren't interrupted.
Starting January 1, 2020, providers must submit claims using MBIs (with a few exceptions), no matter the date of service.
Fee-for-Service Claim Exceptions
- Appeals - Submit either HICN or MBI for claims appeals and related forms
- Claim status query - Submit HICN or MBI to check status of a claim (276 transactions) if earliest date of service on the claim is before January 1, 2020. If checking status of a claim with a date of service on/after January 1, 2020, MBI must be used
- MBI is randomly generated
- MBI consists of 11 non-intelligent characters (number and upper-case letters) and have no special meaning
- Numbers 1-9 and all letters from A-Z, except for S, L, O, I, B, and Z
- MBI Example: 1EG4-TE5-MK73
C - Numeric 1 thru 9 N - Numeric 0 thru 9 AN - Either A or N A - Alphabetic Character (A...Z); Excluding (S, L, O, I, B, Z)
- Position 1 - numeric values 1 thru 9
- Position 2 - alphabetic values A thru Z (minus S, L, O, I, B, Z)
- Position 3 - alpha-numeric values 0 thru 9 and A thru Z (minus S, L, O, I, B, Z)
- Position 4 - numeric values 0 thru 9
- Position 5 - alphabetic values A thru Z (minus S, L, O, I, B, Z)
- Position 6 - alpha-numeric values 0 thru 9 and A thru Z (minus S, L, O, I, B, Z)
- Position 7 - numeric values 0 thru 9
- Position 8 - alphabetic values A thru Z (minus S, L, O, I, B, Z)
- Position 9 - alphabetic values A thru Z (minus S, L, O, I, B, Z)
- Position 10 - numeric values 0 thru 9
- Position 11 - numeric values 0 thru 9
MBIs will fit on claim forms same as a HICN. No spaces or dashes.
Each Medicare beneficiary will receive an MBI.
How to Prepare
- Electronic Remittance Advice (ERA)
- Providers must update beneficiary numbers within their systems to ensure they automatically accept the new MBI from the Remittance Advice (RA) 835 transaction
- For claims submitted with a valid HICN, MBI will return on every ERA
- It will be in "changed HICN" field; 835 Loop 2100, Segment NM1 (Corrected Patient/Insured Name), Field NM109 (Identification Code)
- Beneficiary Intake
- At time of service, ask beneficiaries if he/she has a new Medicare card
- Verify beneficiary's address
- He/she won't get a new card if their address is incorrect
- If address on file is different than address in eligibility response, ask your beneficiary to contact Social Security Administration (SSA) at 1-800-772-1213 to update their records
Eligibility Transaction Responses
Starting in June 2018, providers can use the Noridian Medicare Portal (NMP) as a Look-up Tool for MBIs. To receive the MBI from NMP, the beneficiary must give a provider his/her HICN plus verify their first name, last name, and date of birth. Beneficiaries can also log into http://www.mymedicare.gov to obtain their MBI.
Implementation: January 1, 2020
Regardless of date of service, providers must use the MBI for all Medicare transactions.
- Use MBI as soon as your beneficiary receive their new card
- MBI is effective once new card is received
- Once mailings occur, new Medicare beneficiaries will only be assigned an MBI
- Provider systems must be ready to accept MBI by April 2018
Last Updated May 15, 2019
The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.