Last Modified: 1/24/2020
Location: FL, PR, USVI
Business: Part A, Part B
The transition period is over. You must now submit only the MBI on Medicare claims regardless of the date of service. If not, Medicare will reject claims submitted with the health insurance claim number (HICN), with a few exceptions. This means your payments will be delayed causing you unnecessary rework to correct and resubmit the claim.
Providers must bill the MBI to prevent claim and payment impacts. Take these actions to obtain the MBI:
Ask your patient for their new Medicare card. If they don’t have it, they have the option to call 1-800-MEDICARE (1-800-633-4227) or print their card from Medicare.gov
• Why Can’t I look up an MBI without a Social Security Number?
To protect patient’s new MBI numbers, the Centers for Medicare & Medicaid Services require
the beneficiary’s Social Security number, full name, and date of birth to obtain an MBI through SPOT. CMS instructions require the Social Security number for authentication purposes and there are no plans change this process.
• Obtain the MBI from your remittance advices (RA) received between October 1, 2018 through December 31, 2019 for claims submitted with a valid and active health insurance claim number (HICN) prior to January 1, 2020. The MBIs were returned on the RA during the transition period.
When calling the provider contact center, providers must authenticate with the beneficiary’s MBI, not the HICN. If you cannot authenticate with the MBI, the provider contact center representative will not be able to assist you.
You can use 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 are checking the status of a claim with a date of service on or after January 1, 2020, you must use the MBI.
The beneficiary or their authorized representative can request an MBI change. CMS can also change an MBI. An example is if the MBI is compromised. It’s possible for your patient to seek care before getting a new card with the new MBI.
If you get a HETS eligibility transaction error code (AAA 72) of “invalid member ID,” your patient’s MBI may have changed. There are different scenarios for using the old or new MBIs:
Fee-For-Service (FFS) claims submissions with:
• Dates of service before the MBI change date – use old or new MBIs
• Span-date claims with a “From Date” before the MBI change date – use old or new MBIs
• Dates of service that are entirely on or after the effective date of the MBI change – use new MBIs
FFS eligibility transactions when the:
• Inquiry uses new MBI – we will return all eligibility data.
• Inquiry uses the old MBI and request date or date range overlap the active period for the old MBI – we will return all eligibility data. We will also return the old MBI termination date.
• Inquiry uses the old MBI and request date or date range are entirely on or after the effective date of the new MBI – we will return an error code (AAA 72) of “invalid member ID.”
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.