Medicare Beneficiary Identifier (MBI) Required Starting January 1, 2020

Starting January 1, 2020, you must submit claims using the MBI regardless of the date you performed the service, with limited exceptions.

Fee-for-Service claim exceptions:

  • For appeals and/or audits, you may use either the HICN (Health Insurance Claim Number) or the MBI. For adjustments, the best practice is to adjust using the same submitted Medicare ID (SUBM MED ID) as used on the original claim.
  • Claim status query — 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.
  • Span date claims — you can use the HICN or MBIs for 11X-Inpatient Hospital, 32X-Home Health (home health claims and Request for Anticipated Payments [RAPs]) and 41X-Religious Non-Medical Health Care Institution claims if the “From Date” is before December 31, 2019. If a patient starts receiving services in an inpatient hospital, home health, or religious non-medical health care institution before January 1, 2020, but stops receiving those services after December 31, 2019, you may submit a claim using either the HICN or the MBI, even if it is submitted after December 31, 2019. Since home health claims are submitted for a payment episode, you can send in the episode’s RAP with either the HICN or the MBI prior to December 31, 2019. After December 31, 2019, the MBI must be used on the final claim.

Avoid claim rejections! Use the eServices secure portal if your patient did not bring their new Medicare card with them. And remember, if the new MBI doesn’t work, the number may have changed.

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