What Is Medicare Beneficiary Identifier? Your Guide To Medicare’s New Identifier

What Is Medicare Beneficiary Identifier?

Medicare Beneficiary Identifiers (MBIs) have replaced Health Insurance Claim Numbers (HICNs) based on Social Security Numbers (SSNs) on Medicare cards for billing, eligibility status, and claim status transactions.

Protect the MBI, similar to safeguarding the SSN, as Personally Identifiable Information.

It is mandatory to use MBIs when submitting claims, with a few exceptions, regardless of the service date.

What is Medicare beneficiary identifier
What is Medicare beneficiary identifier? Photo(Pik Superstar)

Medicare Plan Exceptions

Appeals:

Individuals filing appeals have the option to use either the HICN or the MBI for their appeals and related forms.

Adjustments:

Users can indefinitely employ the HICN for certain systems (Drug Data Processing, Risk Adjustment Processing, and Encounter Data) and for all records, without limitation to adjustments.

Reports:

Until further notice, both incoming (quality reporting, Disproportionate Share Hospital data requests, etc.) and outgoing reports (Provider Statistical & Reimbursement Report, etc.) make use of the HICN.

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Retrospective Reporting:

For retrospective reporting, plans can use the HICN when submitting data for older contract years in applicable systems (e.g., Health Plan Management System).

Fee-for-Service Claim Exceptions

Appeals: Either the HICN or the MBI can be used for claims, appeals, and related forms.

Audits: Either the HICN or the MBI is acceptable for audit purposes.

Claim Status Query: Use either the HICN or the MBI to check the status of a claim (276 transactions) if the earliest date of service on the claim is before January 1, 2020.

Use the MBI for claims with a date of service on or after January 1, 2020.

For span-date claims, utilize the HICN for 11X-Inpatient Hospital, 32X-Home Health (including home health final 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).

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Incoming Premium Payments

People with Medicare who don’t receive SSA or RRB benefits and submit premium payments should use the MBI on incoming premium remittances.

However, incoming premium remittances (Part A premiums, Part B premiums, Part D income-related monthly adjustment amounts, etc.) accept the HICN.

Medicare Beneficiary Identifier(MBI) Characteristics

An infographic on MBI Characteristics
An infographic on MBI Characteristics

Clearly different from the HICN and RRB number.

11 characters in length.

Consisting solely of numbers and uppercase letters (without special characters), the system automatically converts lowercase letters to uppercase.

The MBI excludes the letters S, L, O, I, B, and Z to prevent confusion between certain letters and numbers (e.g., between “0” and “O”).

Refer to our MBI format specifications (PDF) for implementing changes to your systems.

Meaning of Medicare Beneficiary Identifier(MBI) Characters

An infographic of the meaning of MBI Characters
An infographic of the meaning of MBI Characters

Each MBI is unique, randomly generated, and its characters are “non-intelligent,” signifying they lack hidden or special meanings.

How do Medicare Beneficiary Identifier(MBI) impact individuals with Medicare?

The introduction of MBIs does not alter Medicare benefits.

Those enrolled in a Medicare Advantage plan or a Medicare drug plan (Part D) should continue using their existing Medicare Advantage;

And/or Medicare drug plan cards as they normally would when seeking healthcare services or filling prescriptions.

Furthermore, individuals with Medicare will require their MBIs when they undergo a change in plans or when they are admitted to the hospital.

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