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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.

Even though we’ll stop using Social Security Numbers to identify Medicare beneficiaries, what won’t change is how your Social Security Number’s used for the IRS and tax reasons, like on your W-9.

Learn, in English or Spanish, what you need to do now and see a timeline of what’s next.

What should providers do to get ready for the new Medicare cards and MBIs?

To get ready to use the new MBIs, make and internally test changes to your practice management systems and business processes by April 2018 before we mail new Medicare cards.  Your billing and office staff might have to coordinate their work to make sure your practice is ready.  Also, if you use vendors to bill Medicare, contact them to find out about their MBI practice management system changes.  It’s especially important that you’re ready for people who are new to Medicare in April 2018 and after because they’ll only get a card with the MBI.

You may want to consider:

If you don’t already have access to your MAC's provider portal, sign up so you can use the provider MBI look-up tool starting in June 2018.  Your office/facility staff might want to coordinate with your billing/administrative staff, who may already have portal access.

You'll also want to attend our calls to get more information about this project; we’ll let you know about upcoming calls through MLN Connects. 

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)

If you submit a claim using your patient’s MBI, this field will be blank.

*New* Medicare remittance advice examples

Medicare Remit Easy Print (MREP) (for Medicare Part B providers & suppliers)

We give free MREP software so you can see and print remittance advice information.

Starting October 1, 2018, we’ll update MREP so it also gives you the MBI when you submit a claim with a valid and active HICN. We’re changing the current MREP Remittance Advice HICN label to Medicare ID (MID) and adding a new MID label and field that will show the MBI number that’s in the ASC X12N 835:

                       Loop 2100, NM109 of the Corrected Patient/Insured Name Segment 

Here’s an MREP example.

PC Print (for Medicare Part A providers & facilities)

Your MAC can give you access to free PC Print software so you can see and print remittance advice information. 

Starting October 1, 2018, we’ll update PC Print so it also gives you the MBI when you submit a claim with a valid and active HICN. We’re changing the current PC

Print Remittance Advice HICN label to Medicare ID (MID) and adding a new MID Corrected (MID COR) label and field which will show the MBI in the ASC X12N 835:

                      Loop 2100, NM109 of the Corrected Patient Name Segment

Here’s a PC Print example.

Standard Paper Remits (SPRs)

Starting October 1, 2018, we’ll update the SPRs so it also gives you the MBI when you submit a claim with a valid and active HICN. Here are SPR examples:

FISS (Medicare Part A/Institutional)

MCS (Medicare Part B/Professional)

VMS (DMEPOS)

Don’t forget that if you submit claims electronically, you’ll get an Electronic Remittance Advice (ERA).  You can also see and print the ERA through MREP and PC Print.

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.

In April 2018, people with Medicare will be able to look up their new MBI numbers and in June 2018, providers will also be able to look up their patients’ new MBI numbers through secure web interfaces that will support quick access to the MBI.

We recently asked our Medicare Administrative Contractors (MACs) to mail letters to all Medicare Fee-For-Service providers.  Your letter will tell you about the new Medicare card project and how to use your MAC’s secure portal so that in June 2018, you’ll be able look up MBIs for your Medicare patients who don’t have their new cards when they come for care. You can use your MAC’s portal to look up any Medicare patient’s MBI, regardless of where the patient lives. Carefully read your letter (here’s a sample) and the print-friendly fact sheet to learn more about how to get ready to use the MBIs by April 2018.

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.

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.  Give your patients a tear-off sheet in English or Spanish to remind them to check their addresses.

Display the New Medicare Card poster in English or Spanish in your office to tell your patients their new cards and new numbers are coming.  You can also go to our Partners & employers page to find and order these and more resources to share with your patients about the new Medicare cards and MBIs.

Eligibility transaction responses

*Update* 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 fee-for-service 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.  Beginning on January 1, 2020, you must use the MBI to get a valid response.

Beginning in April 2018 through the end of the transition period, you can also submit either a HICN or MBI through the Common Working File (CWF) eligibility transaction request to get information; we’re aligning all primary eligibility search criteria, regardless of the system you use to request information as required by the X12 standard. Beginning on January 1, 2020, you must use the MBI to get a valid eligibility response.

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 also return the MBI only through the remittance advice in the same place you get the “changed HICN”,  “Corrected Patient/Insured Name, Identification Code” field, 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

Use the MBI as soon as your patients get their new cards beginning in April 2018. The effective date of the new cards is the date beneficiaries are eligible for Medicare.

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.

We’re 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

See our new Medicare card Partners & employers page for resources you can use when you talk to people with Medicare about the new Medicare cards.

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

Where can providers get help with the new Medicare cards? *New*

The Provider Ombudsman for the New Medicare Card is your resource to make sure we hear and understand any problems you’re having implementing the new Medicare cards. As the Provider Ombudsman, Dr. Eugene Freund will send you information about the new Medicare cards and work inside CMS to settle any implementation problems that come up. Contact the new Medicare card Ombudsman.

 

MAC Provider Portal URLs   New Medicare card Home