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Providers


What does the Social Security Number Removal Initiative (SSNRI) 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 send 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.

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.

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

We’ll tell you in the message field on the eligibility transaction responses when we’ve mailed a new Medicare card to each individual with Medicare. 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

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.

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

We’ll return a message on the eligibility transaction response for a RRB patient. The RRB will keep sending 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.

What does the SSNRI mean for other payers?

Medicaid & supplemental insurers

We’ll give State Medicaid Agencies and supplemental insurers the MBIs for Medicaid-eligible people who also have Medicare before we mail the new Medicare cards. During the transition period, we’ll process and transmit Medicare crossover claims with either the HICN or MBI.

Private payers

For non-Medicare business, private payers won’t have to use the MBI. If you are a supplemental insurer, we’ll continue to use your unique numbers to identify your customers, but after the transition period, you must use the MBI for any Medicare transactions where you would have used the HICN.

Where can providers get more information about the SSNRI?

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.