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Using the MBI


How do providers use MBIs?

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

Beginning in April 2018, we’ll return a message on the eligibility transaction response for a RRB patient.  The message will say, "Railroad Retirement Medicare Beneficiary."

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The RRB will keep mailing cards with the RRB logo, 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 so you know to send those claims to the Specialty Medicare Administrative Contractor (SMAC).

Filing appeals

Use the beneficiary identifier (MBI or HICN) you used to submit the claim that’s under appeal, even after the transition period.

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 return the MBI on the remittance advice 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 return the MBI on the remittance advice for all claims you submit with a valid and active HICN.

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.