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Providers


What do the new Medicare cards mean for providers?

Look at your practice management systems and business processes and determine what changes you need to make to use the new Medicare Beneficiary Identifier (MBI). You’ll need to make those changes and test them by April 2018, before we mail out new Medicare cards.

If you use vendors to bill Medicare, you should contact them to find out about their MBI practice management system changes.

Learn, in English or Spanish, what you need to do now.

How will providers get patients' MBIs?

Beginning in April 2018, we’ll start mailing new Medicare cards with MBIs to people with Medicare. We're now figuring out the best way to mail the cards. We'll keep you posted about critical information so you can be ready to ask your Medicare patients at the time of service if they have a new card with an MBI.

Beginning in October 2018, through the transition period, when you submit a claim using your patient’s valid and active HICN, we’ll return 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)

We're planning:

  • Wide-scale beneficiary outreach that'll help beneficiaries know they need to bring their new Medicare cards and share them when they get medical care.
  • To teach beneficiaries ways to get their MBIs if they've lost their Medicare card.

Providers and people with Medicare will both be able to look up the new MBI numbers through secure web interfaces that will support quick access to the MBI.

How you can help your patients

You can remind your patients to bring their new Medicare cards to their appointments. We’re creating information for you to give to your patients to remind them to bring their cards with them. If your patients or their caregivers can’t give you their MBIs, you can work with their primary care doctors or referring facilities to get the patient information you need.

In the meantime, if the address you have on file is different than the address you get in electronic eligibility transaction responses, ask your patients to correct their address in Medicare’s records by contacting the Social Security Administration. This may require coordination between your billing and office staff.

Eligibility transaction responses

Beginning in April 2018, through the end of 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 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.

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, beginning in October 2018, through the transition period, we’ll return the MBI only through the remittance advice 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.

When do providers use MBIs?

Once patients get their new Medicare cards & MBIs

You can start using the MBI as soon as your patients get their new cards beginning in April 2018.

We'll continue to accept the HICN through the transition period. During the transition period, we’ll:

  • Process claims you submit with either the HICN or the MBI. This will give you and your billing agencies the chance to change your systems if there are problems with claims you submitted using the MBI.
  • Keep track of when claims are sent in and other transactions are done so we can gauge MBI usage.

Once we start mailing out new Medicare cards, people new to Medicare will only be assigned an MBI. Your systems must be ready to accept the MBI by April 2018.

All HICN-based claims have to be received by the January 1, 2020 - the cut-off date. After the transition period ends on January 1, 2020, with a few exceptions, you’ll need to use MBIs on your claims.

Learn more about using the MBI.

Where can providers get more information about the new Medicare cards?

Find more details if you’re a Medicaid, supplemental insurer, or other private payer.

Check back here often; we’ll be updating this webpage when we’ve got new information to share, including new policies and system requirements.

We’re also holding Open Door Forums every quarter so we can get your feedback and hear how things are going.  You can also get the materials from our past Open Door Forums.