How do health care providers & office managers get patients' MBIs?
People with Medicare can look up their MBIs and providers can look up their patients’ MBIs through secure web interfaces that will support quick access to the MBI.
Our Medicare Administrative Contractors (MACs) mailed letters to all Medicare Fee-For-Service providers to tell you how to use your MAC’s secure portal. You’ll be able to use the portal to look up MBIs for your Medicare patients who don’t have their MBIs when they come for care. Using your MAC’s portal, you can look up any Medicare patient’s MBI, regardless of where the patient lives. You can use this tool even after the end of the transition period on December 31, 2019. Carefully read your letter (here’s a sample (PDF)) and the Medicare Learning Network (MLN) print-friendly fact sheet (PDF) to learn more about how to use MBIs.
During the transition period, when you submit a claim using your patient’s valid and active HICN, we’re returning both the HICN and the MBI on every remittance advice. The MBI will be in the same place you currently get the “changed HICN”:
835 Loop 2100, Segment NM1 (Corrected Patient/Insured Name), Field NM109 (Identification Code)
If you submit a claim using your patient’s MBI, this field will be blank.
Medicare remittance advice examples
Medicare Remit Easy Print (MREP) (for Medicare Part B providers & suppliers)
We give free MREP software so you can see and print remittance advice information.
We’ve updated MREP so it also gives you the MBI when you submit a claim with a valid and active HICN. We’re changing the current MREP Remittance Advice HICN label to Medicare ID (MID) and adding a new MID label and field that will show the MBI number that’s in the ASC X12N 835:
Loop 2100, NM109 of the Corrected Patient/Insured Name Segment
Here’s an MREP example (PDF).
PC Print (for Medicare Part A providers & facilities)
Your MAC can give you access to free PC Print software so you can see and print remittance advice information.
We’ve updated PC Print so it also gives you the MBI when you submit a claim with a valid and active HICN. We’re changing the current PC Print Remittance Advice HICN label to Medicare ID (MID) and adding a new MID Corrected (MID COR) label and field which will show the MBI in the ASC X12N 835:
Loop 2100, NM109 of the Corrected Patient Name Segment
Here’s a PC Print example (PDF).
Standard Paper Remits (SPRs)
We updated the SPRs so it also gives you the MBI when you submit a claim with a valid and active HICN. Here are SPR examples:
FISS (PDF) (Medicare Part A/Institutional)
MCS (PDF) (Medicare Part B/Professional)
VMS (PDF) (DMEPOS)
Don’t forget that if you submit claims electronically, you’ll get an Electronic Remittance Advice (ERA). You can also see and print the ERA through MREP and PC Print.
How you can help your patients
You can remind your patients to bring their Medicare cards to their appointments.
Use these resources when you talk to people with Medicare who don't have an MBI.
Eligibility transaction responses
During the transition period, if you submit a HICN on the 270 eligibility transaction request, we’ll tell you in the message field on the 271 response when we’ve mailed a new Medicare card to each individual with fee-for-service Medicare. The message will say, "CMS mailed a Medicare card with a new Medicare Beneficiary Identifier (MBI) to this beneficiary. Medicare providers, please get the new MBI from your patient and save it in your system(s)."
271 Loop 2110C, Segment MSG
Your eligibility service provider can give you this information. Beginning on January 1, 2020, you must use the MBI to get a valid response.
Also, during the transition period, you can submit either a HICN or MBI through the Common Working File (CWF) for eligibility transaction requests. We’re aligning all primary eligibility search criteria when you submit an eligibility request with the MBI, regardless of the system you use to request information, as required by the X12 standard.
Beginning on January 1, 2020, you must use the MBI to get a valid response.
We won’t send you the MBI in eligibility transaction responses when you give us a HICN. We’re aware some providers find the HICN by using a combination of the Social Security Number and Beneficiary Identification Code until they find a match; returning the MBI when providers submit a HICN gives a higher risk of medical identity theft. Therefore, during the transition period, we’re also returning the MBI only through the remittance advice in the same place you get the “changed HICN”, “Corrected Patient/Insured Name, Identification Code” field, for all claims you submit with a valid and active HICN. This is consistent with our policies to reduce medical identity theft.
Using the anti-fraud authorities provided in the Affordable Care Act (P.L. 111-148 and P.L. 111-152) and the Small Business Jobs Act (SBJA) of 2010 (P.L. 111-240), we're protecting taxpayer dollars and beneficiary access to necessary health care services while reducing burden on legitimate providers and suppliers. We have sophisticated predictive analytics technology that uses claims data to prevent and detect fraud, waste, and abuse in the Medicare Fee-for-Service (FFS) program. Also, we continually review and revise claims edits to reject or deny claims that are not payable under Medicare policy. Being cautious in this context helps us decrease the opportunity for medical identity theft.