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Transition period


Transition period

There's now a transition period that will go through December 31, 2019, where you can use either the HICN or the MBI to exchange data with us. 

During the transition period, we’ll monitor the use of HICNs and MBIs to see how many of you are ready to use only MBIs by January 2020. We’ll also actively monitor the transition and adjustment to the new MBIs to make sure of their wide-spread adoption so Medicare operations aren’t interrupted.

Starting January 1, 2020, you have to submit claims using MBIs (with a few exceptions), no matter what date you performed the service.

Medicare plan exceptions:

  • Appeals - People filing appeals can use either the HICN or the MBI for their appeals and related forms.
  • Adjustments - You can use the HICN indefinitely for some systems (Drug Data Processing, Risk Adjustment Processing, and Encounter Data) and for all records, not just adjustments.
    • Reports - We’ll use the HICN on these reports until further notice:
      • Incoming to us (quality reporting, Disproportionate Share Hospital data requests, etc.)
      • Outgoing from us (Provider Statistical & Reimbursement Report, Accountable Care Organization reports, etc.)

Fee-for-Service claim exceptions:

  • Appeals - You can use either the HICN or the MBI for claims appeals and related forms.
  • Audits – You can use either the HICN or the MBI for audit purposes.
  • Claim status query - You can use either the HICN or MBI to check the status of a claim (276 transactions) if the earliest date of service on the claim is before January 1, 2020. If you're checking the status of a claim with a date of service on or after January 1, 2020, you have to use the MBI.
  • Span-date claims - You can use the HICN for 11X-Inpatient Hospital, 32X-Home Health (home health claims & Request for Anticipated Payments (RAPs)), and 41X-Religious Non-Medical Health Care Institution claims if the “From Date” is before the end of the transition period (12/31/2019). You can submit claims received between April 1, 2018 and December 31, 2019 using the HICN or the MBI.  If a patient starts getting services in an inpatient hospital, home health, or religious non-medical health care institution before December 31, 2019, but stops getting those services after December 31, 2019, you may submit a claim using either the HICN or the MBI, even if you submit it after December 31, 2019.
  • Incoming premium payments - People with Medicare who don't get SSA or RRB benefits and submit premium payments should use the MBI on incoming premium remittances. But, we'll accept the HICN on incoming premium remittances after the transition period.  (Part A premiums, Part B premiums, Part D income related monthly adjustment amounts, etc.)
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