10 Things You Need to Do to Gear Up for New Medicare Numbers

Within a matter of months, 150 million Medicare health insurance claim numbers will be changed to new Medicare beneficiary identifier (MBI) numbers.

Out With the Old

Historically, the Medicare beneficiary’s identification Health Insurance Claim Number (HICN) has been used for processing claims and determining eligibility for services across multiple entities—the Social Security Administration, the states’ Railroad Retirement Board, Medicare providers, and health plans, to name a few. But, as you know, the Medicare Access and CHIP Reauthorization Act (MACRA) mandated the removal of the Social Security Number-based HICN from Medicare cards to decrease the Medicare beneficiary vulnerability to identity theft.

Note to providers: This legislation is regarding the health insurance claim number for Medicare beneficiaries. In other words, if you currently use the Social Security Number in your systems or business processes, that practice may continue.

To accommodate the transition to new Medicare numbers, CMS will adjust complex system changes for over 75 systems, conduct extensive outreach in education activities, and analyze the many changes that will be needed to systems and business processes.

The SSN removal solution from the Medicare number must provide the following capabilities:

1. Generate a Medicare Beneficiary Identifier (MBI) for all beneficiaries. This includes existing, currently active, deceased or archived, along with new beneficiaries.
2. Issue new redesigned Medicare cards containing the MBI to existing and new beneficiaries.
3. Modify systems and business processes to accommodate the receipt, transmission, display, and processing of the MBI.

CMS will use an MBI generator to assign 150 million MBIs in the initial enumeration, 60 million active and 90 million deceased/archived, and generate a unique MBI for each new Medicare beneficiary. It will also generate a new unique MBI for a Medicare beneficiary whose identity has been compromised.

New Medicare cards will be mailed by April 2019. In addition to conveying the new MBI, Medicare cards will also have a new design and will omit the gender and signature from the card. The MBI will be unique to each beneficiary, so spouses will have their own number.

11 Alpha-Numeric Bytes

Here’s an example MBI: 1EG4-TE5-MK73

• The MBI’s key positions: 2nd, 5th, 8th, and 9th characters will always be alphabetic and uppercase
• Characters 1, 4, 7, 10, and 11 will always be a number
• The 3rd and 6th characters will be a letter or a number

Dashes aren’t used as part of the MBI and will not be entered into computer systems or used in file formats. MBIs will fit on forms the same way HICNs do.

The MBI Character Order

C – Numeric 1 thru 9 N – Numeric 0 thru 9 AN – Either A or NA – Alphabetic Character (excluding: S, L, O, I, B, Z)

• Position 1 – numeric values 1 thru 9
• Position 2 – alphabetic values A thru Z (minus S, L, O, I, B, Z)
• Position 3 – alpha-numeric values 0 thru 9 and A thru Z (minus S, L, O, I, B, Z)
• Position 4 – numeric values 0 thru 9
• Position 5 – alphabetic values A thru Z (minus S, L, O, I, B, Z)
• Position 6 – alpha-numeric values 0 thru 9 and A thru Z (minus S, L, O, I, B, Z)
• Position 7 – numeric values 0 thru 9
• Position 8 – alphabetic values A thru Z (minus S, L, O, I, B, Z)
• Position 9 – alphabetic values A thru Z (minus S, L, O, I, B, Z)
• Position 10 – numeric values 0 thru 9
• Position 11 – numeric values 0 thru 9

Alphabetic characters will be uppercase and exclude S, L, O, I, B, and Z to enhance legibility and eliminate confusion with numbers. The MBI will not contain any embedded intelligence or special characters.

Making the Shift

The transition period will run from April 2018 through December 31, 2019. CMS will complete its systems and process update to be ready to accept and return the MBI on April 1st, 2018. You must modify your processes and systems to be ready to submit or exchange the MBI by April 1st, 2018.

During the transition period, you may submit either the MBI or the HICN. CMS will accept, use for processing, and return either the MBI or HICN, whichever is submitted on the claim. CMS will also monitor the use of HICNs and MBIs during this period to confirm uninterrupted access to care and to ensure that everyone is ready to use solely MBIs by January 1st, 2020.

CMS will not be mailing 150 million new Medicare cards in one fell swoop. On April 1st, 2018, they will begin issuing cards to beneficiaries in episodic destination-based mailings. To protect beneficiaries from scams associated with sharing the mailing schedule, targeted outreach will occur, including outreach to healthcare providers, shortly before card delivery is scheduled for a given geographical area. Distribution of new cards will continue for some time, during which, from April 2018 through December 31st, 2019, you will be permitted to use either the MBI or HICN, as CMS will accept both.

CMS is reconfiguring the HIPAA Eligibility Transaction System (HETS) to inform providers who check a beneficiary’s eligibility if CMS has mailed that beneficiary’s new Medicare card. Starting in June 2018, providers will be able to look up your Medicare patient’s new Medicare number through your Medicare Administrative Contractor’s secure web portal.

From October 2018 to the end of the transition period, when a valid and active HICN is submitted on Medicare fee-for-service claims, both the HICN and the MBI will be returned on the remittance advice. However, you must submit either the HICN or the MBI, not both for the same transaction. Once the transition period ends, you must use the MBI in the same field where you previously submitted the HICN.

The MBI will be in the same place you currently get the “changed HICN,” which is 835 Loop 2100, Segment NM1, which is Corrected Patient/Insured Name, Field NM109 Identification Code, the use of HICN and MBI for the same person with Medicare on the same batch of claims.

Medicare Advantage and Prescription Drug Plans

Medicare Advantage and Prescription Drug plans will continue to assign and use their own identifiers on their health insurance cards. For patients in these plans, continue to ask for and use the plans’ health insurance cards.

Railroad Retirement Board & Private Payers

For Railroad Retirement Board beneficiaries, the RRB will continue to send cards with the RRB logo, but you can’t tell from looking at the MBI if beneficiaries are eligible as railroad retirees for Medicare. Starting in April 2018, CMS will return a message on the eligibility transaction response for an RRB patient. The message will say “Railroad Retirement Medicare Beneficiary.” Again, that will be in 271 Loop 2110C, Segment MSG. Medicare providers must program their systems to identify RRB beneficiaries, so they know to send those claims to the Specialty Medicare Administrative Contractor.

For non-Medicare business, private payers won’t have to use the MBI. We’ll continue to use supplemental insurer’s unique numbers to identify customers, but after the transition period, supplemental insurers must use the MBI for any Medicare transaction where they would have used the HICN. In addition, CMS is working to develop capabilities where providers will be able to access a beneficiary’s MBI through a secured lookup tool at the point of service. In instances in which a beneficiary does not have a new Medicare card at the point of care, this lookup tool will give providers a secure mechanism to access a beneficiary’s MBI.

Exceptions Beyond Transition

Beneficiaries, providers, and plans will no longer use the HICN for internal and most external purposes after the transition period starting January 2020. However, once the transition period is over, you’ll still be able to use the HICN in certain situations.

For adjustments, you can use the HICN indefinitely for some systems, drug data processing, risk adjustment processing and encounter data, coordination of benefits, and for all records not just adjustments. And for reports—such as quality reporting, Disproportionate Share Hospital data requests, etc.—CMS will use the HICN until further notice.

You can either use the HICN or the MBI for claim status and appeals. Span-date claims, you can use the HICN for 11X Inpatient Hospital, 32X Home Health, and 41X Religious Non-Medical Health Care Institution claims. If the from date is before the end of the transition period, which is 12/31/2019, you can submit claims received between April 1st, 2018 and December 31st, 2019 using the HICN or the MBI. If a patient starts getting services in an inpatient hospital, home health, or religious non-medical health care institution before December 31st, 2019, but stops getting those services after December 31st, 2019, you may submit a claim using either the HICN or the MBI, even after December 31st, 2019.

Other exceptions include incoming premium payments. People with Medicare who don’t get SSA or RRB benefits and submit premium payments should use the MBI on incoming premium remittances. But CMS will accept the HICN on incoming premium remittances after the transition period for Part A premiums, Part B premiums, Part D income related monthly adjustment, and items of this nature.

What You Need to Do to Get Ready

1. Ensure that your system will accept the 11-digit alphanumeric MBI. If you use vendors to bill Medicare, ask them about their MBI practice management system changes to make sure they’re ready. Your software and business processes must be equipped to accept all transactions—billing, claim status, eligibility status, interactions with Medicare Administrative Contractor (MAC) contact centers, etc.
2. Test changes to your practice management systems and business processes by April 2018.
3. CMS recommends that providers subscribe to the weekly MLN Connects newsletter for updates and new information.
4. Ask questions. Attend CMS’s quarterly open-door provider forums to stay informed. You can also direct your questions on the New Medicare Card Project to NewMedicareCardSSNRemoval@cms.hhs.gov.
5. Visit the Partners & Employers section at cms.gov/new card for various resources and tools, including: flyers, tear-off pads, posters, and conference cards for beneficiaries, as well as other sources of information.
6. Verify your patients’ addresses. For addresses on file that differ from those in electronic eligibility transaction responses, encourage your patients to update their address in Medicare’s records at SSA using ssa.gov/myaccount or calling 1-800-772-1213. Give patients a tear-off sheet in English or Spanish instructing them to check their address and emphasize the importance of this action, as patients will not receive their new card if their address is incorrect.
7. Display the New Medicare Card poster in English or Spanish in your office to tell your patients that their new cards are coming. You’ll be informed by CMS of impending mailings in your geographic region and should alert patients to watch their mail.
8. You must protect your patients’ MBIs as confidential and Personally Identifiable Information, restricting use to Medicare-related business.
9. Inform your patients to protect their new Medicare number like a credit card and only share it with trusted providers. Advise your Medicare beneficiaries to destroy their old cards.
10. Make sure you can access the new provider portal at cms.gov/new card to obtain a patient’s MBI (in the event that he or she doesn’t know it). If you don’t have access to your MAC’s provider portal, sign up so you can use the MBI look-up tool starting in June 2018. (If your Medicare patients don’t want to give you their SSN, they can log into www.mymedicare.gov to get their MBI.)

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References:

CMS 11/1/16 Open Door Forum slides: https://www.cms.gov/Medicare/New-Medicare-Card/index.html

CMS 03/20/18 Open Door Forum: New Medicare Card Project