Medicare has issued beneficiaries their new member cards with Medicare Beneficiary Identifiers or MBI, in lieu of using their Social Security Numbers (SSN) for over two years now. In 2019, Medicare would accept either a beneficiary’s Social Security Number or their Medicare Beneficiary Identifier on claims.
Starting January 1, 2020, the Centers of Medicare and Medicaid Services (CMS) will reject any Medicare claims submitted with the identification of the beneficiary only being their Social Security Number. The best, simplest way to prevent claim denials is to be sure all of your patients have their new member card.
The claim will be denied with one of the following codes if the Medicare Beneficiary Identifier (MBI) is not used on claims after January 1, 2020:
Electronic Claim Reject Codes: Claim Status Category Code of A7 which is acknowledgement rejected for invalid information, a Claim Status Code of 164 which is entity’s contract and/or member number, and an Entity Code of IL which is subscriber.
Paper Claims Notices: Claim Adjustment Reason Code (CARC) 16 which stands for Claim and/or Service lacks information or has submission and/or billing error(s) and Remittance Advice Remark Code (RARC) N382 which stands for Missing, Incomplete, and/or Invalid Patient Identifier.
Centers for Medicare and Medicaid Services (CMS) says that currently about 87% of claims are being submitted with the Medicare Beneficiary Identifier. The other 13% of claims are still using the patient’s Social Security Number, but starting January 1, 2020 the claims with just the SSN will be rejected and payment will not be received.
If a patient does not know their Medicare Beneficiary Identifier (MBI), you can look it up through the Medicare Administrative Contractor’s portal at any point in time. You can also find the patient’s MBI on the remittance advice from Medicare.