Healthcare Provider Solutions

HPS reported on the coming changes to the Medicare cards a few months ago. Today we offer more answers as have been gathered from CMS via the Medicare Learning Network page of the CMS site.

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires the removal of Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions such as billing, eligibility status and claim status.

Why are the new Medicare cards important?

The biggest reason for the removal of the SSN from the Medicare cards is to fight medical identity theft for people with the Medicare benefit. This will offer better protection of private healthcare and financial information and the federal health care benefit and service payments.

What’s the timeline for the new Medicare cards?

CMS has already started this work and want to help with the shift to the new MBIs by April 2018. Beginning in April 2018, CMS will start mailing the new Medicare cards with the MBI to all people with Medicare. CMS will randomize card mailing by geographic location.

Will there be testing for systems that use the MBI?

CMS will test systems that will use the MBI, including enhanced integration testing (EIT) for new or high-risk systems. CMS is not offering end-to-end testing with Medicare fee-for-service claims processing systems because these partners (intermediaries, administrative contractors, etc.) will be able to use either HICNs or MBIs to submit claims during the transition period. The transition period can be used as a live test and make adjustments as necessary, yet still have claims submitted and processed with HICNs until the transition period ends.

Transition period

CMS plan the transition period for the use of either the HICN or the MBI to exchange data. The transition period will begin no earlier than April 1, 2018 and run through December 31, 2019. During the transition period, CMS will monitor the use of HICNs and MBIs to see how many are ready to use only MBIs by January 2020. CMS will actively monitor the transition and adjustment to the new MBIs to make sure of their wide-spread adoption so Medicare operations aren’t interrupted. After the transition period ends on January 1, 2020, all will need to use MBIs on claims with a few exceptions when you can use either the HICN or MBI.

Fee-for-Service claim exceptions:

  • Appeals – You can use either the HICN or the MBI for claims appeals and related forms.
  • Claim status query – You can use either 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’re checking the status of a claim with a date of service on or after January 1, 2020, you have to use the MBI.
  • Span-date claims – You can use the HICN for 32X-Home Health (home health claims & Request for Anticipated Payments (RAPs) if the “From Date” is before the end of the transition period (12/31/2019). You can submit claims received between April 1, 2018 and December 31, 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 31, 2019, but stops getting those services after December
    31, 2019, you may submit a claim using either the HICN or the MBI, even if you submit it after December 31, 2019.

How will the MBI look?

CMS has assigned all people with Medicare benefits a new, unique Medicare number, which contains a combination of numbers and uppercase letters.

Stay tuned for more updates from HPS as we approach April 2018!