Under a 2015 law, Medicare must cease using patient Social Security numbers by 2019. To make the change, the Centers for Medicare and Medicaid Services will start issuing new beneficiary cards with an alphanumeric identifier in 2018. During the transition period, you can submit claims with either patients’ Social Security number or their new Medicare beneficiary identifier.
Here’s what you need to know about the change.
- All beneficiaries should now have new cards. Many Medicare Administrative Contractors are adding look up tools for easier verification. Be sure you are signed up with your MAC to access to their online portal and receive email updates. Your remittance advice should also provide the new number.
- Transition period (SSN or new identifier accepted on claims): April 1, 2018, to Dec. 31, 2019.
- What it means for you: You will need to update your practice management systems to accept the new patient identifier. Be sure to check with your vendor to see if they will provide an update or if you need to manually update your system.
- Why the change: An effort to decrease identity fraud, included in the Medicare Access and CHIP Reauthorization Act of 2015.
- Claims not using MBI beginning Jan. 1, 2020 will be denied. You will receive electronic claim status rejection codes:
- A7 Acknowledgement rejected for invalid information
- 164 Entity's contract/member number
- IL Subscriber
Paper claim rejections include: 16 Claim/service lacks information or has submission/billing error(s) N382 Missing/incomplete/invalid patient identifier
- Exceptions to Jan. 1, 2019 deadline:
- For appeals and audits, either Health insurance claim number (HICN) or MBI will be accepted.
- For patients with inpatient status beginning before Dec. 31, 2019 and ending after Dec. 21, 2019, either HICN or MBI will be accepted.
- For patients with services prior to January 1, 2020, either HICN or MBI will be accepted when checking the status of a claim.
- A QR code, which is a type of bar code, may now be printed on the new Medicare cards issued to beneficiaries. This will not impact practices as its only use verifies the card is being sent to the correct beneficiary. Railroad Medicare cards will have the code on the front, however traditional Medicare cards will include it on the back. The notification is to alert practices that these cards are valid.
- Assigned MBI may change. Beneficiaries or their representative may request a change to their new identifier. CMS will issue a new card upon that request. Remember always to ask for the most current payer information. This can also be verified with your MAC lookup tool, and on the remittance advice.
- Beware of 0 versus O: Practices are reminded that certain characters are not be used in the Medicare Beneficiary Identifier (MBI) including S, L, O, I, B and Z. The number “0” will be included and should not be mistaken for the letter “O”.
What the New Medicare Card Format Looks Like
The new Medicare patient identifier follows the alphanumeric format below. Use the key to correctly update your practice management system.
Each type may be a capital letter or number. The key below demonstrates each position of the 11-character ID:
C: Numeric 1-9
A: Alpha character (A-Z) except S, L, O, I, B and Z
N: Numeric 0-9
AN: A or N
Medicare vs. Railroad Medicare
Unlike the previous cards, Railroad Medicare beneficiaries will not have a unique identifier in their card number. Instead, their cards will include a separate logo that distinguishes their benefits.
Ombudsman Available to Physician Practices
CMS has now made accessible an ombudsman, Dr. Eugene Freund, for physician assistance. His purpose is to ensure any outstanding concerns and implementation issues are addressed. He can be contacted via email at NMCProviderQuestions@cms.hhs.gov.
- April 2018: CMS starts mailing new cards. You should be ready to submit claims with the new beneficiary identifier. When verifying benefits, you will receive a message if the patient has received his or her new card and identifier.
- June 2018: Medicare Administrative Carriers will be able to give practices the new patient identifier through the secure portals.
- October 2018: Remittance advice statements will start to use the new identifier. You can still submit claims with the existing Social Security number, but the remittance advice will show the new identifier.
- January 2020: Dates of service submitted must provide the new identifier in order to be processed. Claims will be denied if the beneficiary is unable to be verified with the MBI.
Resources to Prepare Your Patients
Help prepare your patients for the card switch by displaying a printout of its design. Print this PDF and display in your office to ensure your patients are aware of this major change. CMS has provided instructions for patients who state they haven’t received a new card:
- Check to see if you have an unopened plain white envelope from the Department of Health and Human Services.
- Sign into MyMedicare.gov to get their new numbers or print official cards. An account will need to be created.
- Call 1-800-MEDICARE (1-800-633-4227).
CMS Fact Sheet
Frequently Asked Questions
Watch this short presentation about the upcoming changes to Medicare ID cards in 2018.