The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 prohibits use of social security numbers as a Medicare beneficiary’s identification number. This action is intended to reduce risk of identity theft overall and medical identity theft in particular.
At present, a social security number forms the basis of each beneficiary’s Health Insurance Claim Number (HICN). The Centers for Medicare & Medicaid Services (CMS) will generate new Medicare Beneficiary Identifiers (MBI) for all current, new, deceased and archived beneficiaries.
The HICN consists of the social security number of the primary account holder with a 1 or 2-character beneficiary identifier. In contrast, the MBI will be unique to each beneficiary and will consist of 11 uppercase and numeric characters. The 2nd, 5th,8th and 9th characters will be a letter and the MBI will not include the letters B, I, L, O, S or Z.
Example of a HICN: 123-45-6789-A1
Example of an MBI: 1EG4-TE5-MK72
The transition period will run from April 1, 2018 through December 31, 2019. CMS will start the process of mailing new Medicare cards with the new MBI to current and new beneficiaries on April 1, 2018. That process will be completed by April 1, 2019. CMS will also work with states whose Medicaid programs use the HICN to transition those programs to the MBI.
Claims may be submitted with either the old HICN or the new MBI during the transition period. However, because patients new to the Medicare program on/after April 1, 2018 will receive only the new number, all practices must be able to accept, receive and transmit information with the new number by this date. Any required changes to your systems and processes must be identified, tested and in place by April 1, 2018. If you have not already started this process, now is the time to check with your vendors to ensure readiness.
There are several ways that you can get your patients’ new MBI. These include:
- From the patient: A patient who has received his/her new Medicare card and number can present it at time of service. By watching for updates to CMS's New Medicare Card Mailing Strategy (PDF), you can determine when to start looking for the new number for your patients.
- From the Medicare Remittance Advice: You may submit claims using either the old or the new format through December 31, 2019. Starting October 1, 2018 your Medicare Remittance Advice will include a new field to show the new MBI for claims that used the old number.
- From your Medicare Administrative Contractor (MAC): Starting in June 2018, each MAC will have a secure look up portal on its website.
For more information, please review and watch for updates to the information on the CMS' New Medicare Card webpage.