MBI Transition Period Coming to an End

As we wrap up Q3, I’m seeing an increase in questions about the MBI and using it on Medicare eligibility questions. I suspect this is because the transition period for using the HICN or the MBI is coming to an end. Beginning January 1st, 2020 you will no longer be able to use the HICN for eligibility or claims (with a few exceptions).

One of the complaints I’ve seen is that HETS is returning errors in some cases when eligibility is searched using the MBI that’s on the card. I’ve heard that it’s possible the beneficiary’s MBI may change from the one that was originally issued. I’m validating this with CMS and will get back to you on what I find out. The majority of the problems I’ve seen with the MBI have been user keying errors so please make sure you’re keying exactly what’s on the card. If you still haven’t gotten access to the Medicare MBI lookup tool, I highly suggest that you sign up before the end of the year. If you’ve been using it, please leave me a comment and let me know what your experience has been.

Below is a list of exceptions that CMS has published for still using the HICN. I wasn’t aware of most of these so I thought I would pass them along.

Medicare plan exceptions:

• Appeals – People filing appeals can use either the HICN or the MBI for their appeals and related forms.
• Adjustments – You can use the HICN indefinitely for some systems (Drug Data Processing, Risk Adjustment Processing, and Encounter Data) and for all records, not just adjustments.
  • Reports – We’re using the HICN on these reports until further notice:
    • Incoming to us (quality reporting, Disproportionate Share Hospital data requests, etc.).
    • Outgoing from us (Provider Statistical & Reimbursement Report, Accountable Care Organization reports, etc.).
• Retrospective reporting – Plans can use the HICN when submitting data for older contract years for applicable systems (e.g., Health Plan Management System).

Fee-for-Service claim exceptions:

• Appeals – You can use either the HICN or the MBI for claims, appeals and related forms.
• Audits – You can use either the HICN or the MBI for audit purposes.
• Claim status query – You can use either the HICN or the 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 11X-Inpatient Hospital, 32X-Home Health (home health claims & Request for Anticipated Payments (RAPs)), and 41X-Religious Non-Medical Health Care Institution claims 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 either 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.
• 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, we’ll accept the HICN on incoming premium remittances after the transition period.  (Part A premiums, Part B premiums, Part D income related monthly adjustment amounts, etc.)
• We’re monitoring the use of HICNs and MBIs to see how many of you are using MBIs. We’re also actively monitoring the transition to MBIs to be sure Medicare operations aren’t interrupted.