Last Modified: 7/31/2018 Location: FL, PR, USVI Business: Part A, Part B
Accuracy of beneficiary information FAQ
Medicare beneficiary numbers are changing in 2018
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Medicare number on new Medicare cards starting in 2018 for Medicare transactions like billing, eligibility status, and claim status. Find more details here.
Q: How can I ensure that beneficiary identification information submitted on my claim matches information on file for the patient?
A: It is critical that beneficiary identification information submitted on claims is identical to the information found on the beneficiary's most recent Medicare card. Make a copy of the Medicare card for your records.
• If you are a laboratory, radiology department, or other entity to which the patient or their service(s) may have been referred, obtain a copy of the patient's Medicare card from the referring source prior to submitting your claim and verify the information indicated below.
Use the beneficiary's Medicare card to verify the following:
• Medicare number: Verify the beneficiary's Medicare ID number, ensuring it has not been changed.
• Beneficiary's name: Verify the beneficiary's name indicated on your claim is exactly as it reads on their Medicare card. For example, do not indicate "Betty" if the card reads "Elizabeth."
• Effective date: Verify the effective date of coverage.
• Date of birth: Verify the beneficiary's date of birth. Be careful not to transpose numbers, especially when entering ID numbers.
• Part A and/or Part B: Verify which part of the Medicare program the beneficiary is enrolled, either A or B or both.
Eligibility dates: Click here for ways to verify current and previous dates of service eligibility.
Source: CMS internet-only manual (IOM), publication 100-09, chapter 6, section 50.1
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