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Using MBIs


How do health care providers & office managers use MBIs?

Medicare Beneficiary Identifiers (MBIs) are confidential

The MBI is Personally Identifiable Information. You must protect the MBI and only share it for Medicare-related business, just as you currently do with the HICN.

Checking eligibility

During the transition period, use the MBI or the HICN to check Medicare eligibility. Once the transition period ends you must use the MBI to check eligibility.

Railroad Retirement Board (RRB) beneficiaries

*Updated* We’ll return a message on the MBI eligibility transaction response for every RRB patient MBI inquiry.  The message says, "Railroad Retirement Medicare Beneficiary."

271 Loop 2110C, Segment MSG

The RRB will keep mailing cards with the RRB logo in the upper left corner, and “Railroad Retirement Board” at the bottom, but you can’t tell from looking at the MBI if your patients are eligible for Medicare because they’re railroad retirees.  Program your system to identify RRB patients based on the image of the card so you know to send those claims to the Specialty Medicare Administrative Contractor (SMAC).

Using qualifiers

For ASC X12N transactions, we’ll use the Member Identification Number (MI) Identification Code Qualifier as follows:

  • ASC X12N 270/271: Loop 2110C, NM1 – Subscriber Name Segment, NM108  - Identification Code Qualifier Element Detail
  • ASC X12N 276/277: Loop 2100D, NM1 – Subscriber Name Segment, NM108 – Identification Code Qualifier Element Detail
  • Starting October 2018: ASC X12N 835: Loop 2100, NM1 – Patient Name Segment , NM108 – Identification Code Qualifier Element Detail
  • ASC X12N 837 I and P : Loop 2010BA, NM1 – Subscriber Name Segment, NM108 – Identification Code Qualifier Element Detail
  • ASC X12N 278: Loop 2010C, NM1 – Subscriber Name Segment, NM108 – Identification Code Qualifier Element Detail

Reporting relationship to insured

Because each MBI is randomly generated and unique to each person with Medicare, on claims, you'll report SELF as the relationship to the insured.

On the UB-04:

FL 59      Patient’s Relationship to Insured (Loop 20008) (SBR02):

18           Self

On the Paper Claim 1500:

FL 6        Patient’s Relationship to Insured (Loop 20008 2000C) (SBR02):

Self

Giving the HICN or MBI on outgoing transactions

During the transition period, we’ll return the same beneficiary identifier to you that you submitted on the incoming transaction. Beginning in October 2018, through the transition period, we’ll also return the MBI on the remittance advice in the same place you get the “changed  HICN”,  “Corrected Patient/Insured Name, Identification Code” field, when you submit a claim using your patient’s valid and active HICN.

Using the HICN & MBI for the same patient on the same batch of claims

During the transition period, we’ll process all claims with either the HICN or MBI, even when both are in the same batch. Beginning in October 2018, through the transition period, we’ll also return the MBI in the same place you get the “changed HICN”, “Corrected Patient/Insured Name, Identification Code” field, on the remittance advice for all claims you submit with a valid and active HICN.

How do I use the MBI for informational only & no-pay claims?

During the transition period, you can submit either the HICN or MBI to report informational only and no-pay claims in the same place you report the HICN today.  Starting January 1, 2020, you must submit informational only and no-pay claims using the MBI in the same place you currently report the HICN today - Loop 2010BA, NM1 – Subscriber Name Segment, NM109 (Identification Code for both 837I & P).

Electronic or paper transactions

During the transition period, you can use either the HICN or the MBI in the same field where you’ve always put the HICN. You can’t submit both numbers on the same transaction. Once the transition period ends, you must use the MBI in the same field where you previously submitted the HICN.

After the transition period, the remittance advice will tell you if claims are rejected because they don’t use an MBI or if they’re rejected or denied for other reasons. If your claims are rejected because you didn’t use the MBI, get the MBI from your patient and follow existing procedures to correct and resubmit rejected claims.

Episode claims

How should I submit Home Health (HH) claims with episodes that end after the new Medicare cards start being used?

You’ll have to use MBIs on HH claims and Requests for Anticipated Payment (RAPs) with a through date on or after January 1, 2020. Since you submit HH claims for a 60-day payment episode, there may be times when an episode ends after we start using the MBIs. If this happens, you can send in the episode’s RAP with either the HICN or the MBI, but you have to use the MBI when you send in the claim that goes with it.

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