Health & drug plans
What do the new Medicare cards mean for plans?
Medicare health and drug plans contracting or working with us need to look at their systems and business processes and determine what changes to make in order to use the new Medicare Beneficiary Identifier (MBI). Plans will need to make those changes and test them now.
You don’t need to change your members’ ID numbers unless those ID numbers include whole or parts of their Social Security Numbers. We urge you to keep using the unique identifiers that you’ve been using and not to include MBIs on your members’ ID cards.
Plans can then keep exchanging data with us so we can make sure:
- People in Medicare health and drug plans have a smooth transition to using MBIs.
- Eligible Retiree Drug Subsidy (RDS) sponsors receive subsidies.
How can plans get MBIs?
MARx will make a monthly crosswalk data file at the MAO/PDP Contract level. Every month during the transition period, MARx will send out the file to help MAOs and Part D sponsors determine or match their beneficiaries’ Health Insurance Claim Numbers (HICNs) and MBIs.
In March 2018, Plans will get an “initial” (one-time only) HICN to MBI crosswalk file for past (back to 2006) and present membership. After the initial crosswalk file, a monthly file will be sent to Plans with any new enrollment changes.
During and after the transition period, MARx will only show the MBI on files and reports. The MARx UI will show both the HICN and the MBI during the transition, but only the MBI when the transition’s over.
If you send a HICN after the transition period's over, we won’t send you a new transaction reply code. MARx will send you the same transaction code that that’s sent now (008) when a health insurance claim number can’t be found.
How do plans use MBIs?
Even though we’re moving to MBIs for claims and other Medicare business, this change shouldn’t affect how you use Social Security numbers (SSNs) to identify and verify your members.
We’re using a crosswalk that’ll show you HICNs and the MBIs that go with them. So, if you use HICNs for crossover claims processing, you’ll also have access to MBIs so you’ll be ready for Medicare crossover claims starting in April 2018. For crossover claims processing, during and even after the transition period, we’ll keep sending you plan membership IDs like we do now.
We won’t add beneficiaries who’ve cancelled their plan enrollment and have never existed in the plan to the MARx Crosswalk File. We’ll only add those beneficiaries who are now enrolled or were enrolled in a plan to the MARx Crosswalk File.
Using the card image
You can use the new Medicare card image in your plan materials, and in digital formats like video, on the web, or however you need to for business purposes. You can get a high resolution image of the card or you can use a generic card image you've made in videos or in other online or electronic materials. We won’t provide a generic image for use.
You don’t have to resubmit marketing materials that have already been approved or accepted if the only change you've made is to add the new Medicare card image.
The new Medicare card image may not be altered in any way, but you can use a black and white version of the image for print materials.
How do plans protect MBIs?
Like SSNs and Health Insurance Claim Numbers (HICNs), MBIs are confidential and should be protected as Personally Identifiable Information. Here’s how plans can protect the integrity of MBIs while continuing their work:
Don’t give MBIs over the phone
Plan call centers currently don’t give HICNs to beneficiaries over the phone. Once MBIs start being used, plan call centers also shouldn’t give MBIs to a beneficiaries over the phone. Beneficiaries can usually get most of their health plan services with their plan IDs, so they shouldn’t need their MBIs.
Plans should always confirm they have the right address on file for beneficiaries and tell them to make sure that the Social Security Administration has their correct mailing address.
If beneficiaries call before October 1, 2018 to ask for their MBIs because they haven’t gotten their new Medicare cards yet, plans should let them know that the new Medicare cards are still being mailed.
Use MBIs on standardized materials
The HICN is now used on many standardized forms and letters. We’ll be revising these materials just for MBI use, but until they're ready, plans should keeping using the forms they have with either the HICN or MBI as appropriate.
Share MBIs with downstream partners
Plans can share MBIs with downstream partners for Medicare-related business (payments, treatment and healthcare operations) like they share HICNs today. Plans should make sure MBIs are secure and use the HIPAA “Minimum Necessary” guidelines.
Keep HICN/MBI crosswalk records
Plans should keep records as required by existing federal and state regulations.
Where can plans get more information about the new Medicare cards?
To learn more, you can:
- Read our frequently asked questions
- Get our Open Door Forum training materials
- Log in to HPMS to read the most recent updates on the new Medicare cards and MBIs for Medicare Advantage and Part D plans
- Get updates for RDS plan sponsors and vendors
- You can also check our new Medicare card Outreach & education page to get information for you and resources you can use when you talk to people with Medicare about the new Medicare cards
- Check out our new Medicare card Partners & employers page for resources you can use when you talk to people with Medicare about the new Medicare cards
- Find Drug Data Processing System and Payment Reconciliation System information
- Find Medicare managed care and Medicare prescription drug enrollment guidance information
- Get the CY 2018 call letter to help plans prepare their bids
We’ll give more details about the new Medicare cards as we have them. Plans will get these details the same way we usually send them information about other topics, such as the Health Plan Management System (HPMS), the RDS Program website, RDS program correspondence, Medicare Advantage Prescription Drug (MAPD) Release Letters, and updates to the Plan Communications Users Guide.
You can also check back here on our webpage or email us your technical questions to the right email box below:
- Medicare Health & Drug Plan Enrollment
- Drug Data Processing System (DDPS) & Payment Reconciliation System (PRS)
- Medicare Part D Coordination of Benefits
- Encounter Data System (EDS)
- Risk Adjustment Suite of Systems (RASS)
- Medicare Advantage-Prescription Drug (MARx) System
- Health Plan Management System (HPMS)
- Page last Modified: 05/18/2018 8:11 AM
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