Beginning January 1, 2020 claims must be submitted using the MBI no matter what date you performed the service, with a few exceptions.
Exceptions for Fee-for-Service claims:
For appeals, you may use either the old Medicare number or the MBI.
For audit purposes, you can use either the old Medicare number or the MBI.
Claim status query, you can use the old Medicare number 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 old Medicare number or MBIs for 11X-Inpatient Hospital, 32X- Home Health (home health claims and Request for Anticipated Payments [RAPs]) and 41X-Religious Non-Medical Health Care Institution claims if the “From Date” is before December 31, 2019. 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 old Medicare number or the MBI, even if you submit it after December 31, 2019. Since you submit home health claims for a 60-day payment episode, you can send in the episode’s RAP with either the old Medicare number or the MBI, but after December 31, 2019, you have to use the MBI when you send in the final claim that goes with it.
Note: The MBI doesn’t include the letters S, L, O, I, B, and Z to avoid confusion between some letters and numbers (e.g., between “0” and “O”).
Medicare beneficiaries or their authorized representatives can ask to change their MBIs. For example, if the MBIs are compromised:
CMS can change MBIs
CMS does NOT issue temporary MBIs
CMS does NOT require a beneficiary to "activate" a new MBI
It's possible for a beneficiary to seek and get care before getting a new card with the new MBI in the mail
If a provider gets an eligibility transaction error code (AAA 72) of "invalid member ID," the beneficiary's MBI may have been changed
Providers can do a historic eligibility search to get the termination date of the old MBI
Providers can get the new MBI from the secure MBI look-up tool
MBI Lookup Tool - Allows you to find a patient's MBI using their name, date of birth, and social security number. A free Novitasphere account is required to access this tool.
MBI / IVR Conversion Tool - Convert your patient's Medicare Beneficiary ID number (MBI), Provider Transaction Access Number (PTAN), or Document Control Number (DCN) into the telephone key pad button sequence required by the IVR as an alternative to speaking.
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