January 01, 2020
Area(s) of Interest: Practice Management
Physicians are reminded that the transition period to the new Medicare Beneficiary Identification (MBI) numbers ended on December 31, 2019. Beginning January 1, 2020, providers must use only the new MBI number for Medicare transactions regardless of the date of service with few exceptions.
Only the following exceptions will allow a provider to use either the old SSN-based health insurance claim number (HICN) or MBI on or after January 1, 2020:
Appeals – You can use either HICNs or MBIs for claim appeals and related forms.
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 MBI for Inpatient Hospital, Home Health and Religious Non-Medical Health Care Institution claims if the "From Date" is before the end of the transition period (December 31, 2019). Dates of service that are entirely on or after the effective date of the MBI change must use the new MBIs.
Providers who submit claims with HICNs on or after January 1, 2020, will receive the following rejection codes:
Electronic claims – Claims Status Category Code A7 (acknowledgment rejected for invalid information), Claims Status Code 164 (entity’s contract/member number), or Entity Code IL (subscriber)
Paper claims – Claim Adjustment Reason Code 16 “(claim/service lacks information or has submission/billing error[s]) or Remittance Advice Remark Code N382 (missing/incomplete/invalid patient identifier)
To help physicians navigate the MBI transition, CMS has developed a web page where health care providers and office managers can get more information about the transition to MBIs.
The California Medical Association also recently hosted a webinar that covers changes to the Medicare program for 2020 and offer tips to ensure practices are complying with Medicare requirements. The free webinar is now available for on-demand viewing.
Contact: Cheryl Bradley, (213) 226-0338 or firstname.lastname@example.org.