Medicare Beneficiary Identifier (MBI)
Every person with Medicare has been assigned a Medicare Beneficiary Identifier (MBI) and issued a new Medicare card. The MBI is confidential and should be protected as Personally Identifiable Information.
Effective January 1, 2020: The MBI is required for all transactions submitted to Medicare including (not all inclusive)
- Claim Submission: electronic and paper claim submissions for all dates of service. Claims received with HICNs will be rejected, even for dates of service prior to January 1, 2020.
- Electronic claims received after 5:00 PM ET on December 31, 2019 will reject with the following codes: Claims Status Category Code of A7 (acknowledgment rejected for invalid information), a Claims Status Code of 164 (entity's contract/member number), and an Entity Code of IL (subscriber)
- Paper claim rejections: Claim Adjustment Reason Code (CARC) 16 "Claim/service lacks information or has submission/billing error(s)" and Remittance Advice Remark Code (RARC) N382 "Missing/incomplete/invalid patient identifier"
- Reopening requests for all dates of service
- Prior Authorization requests
- Advance Determination of Medicare Coverage (ADMC) requests
- Beneficiary information/eligibility inquiries: written inquiries or self-service options.
- General inquiries and written correspondence
CGS encourages suppliers to use the MBI for all workloads. However, there are a few exceptions when you can use either the HICN after January 1, 2020, if you are unable to obtain the MBI:
- Appeals – You should use the MBI if available, but are allowed to use HICNs for claim appeals and related forms if the MBI is unavailable.
- Claim status query – You should use the MBI if available, but are allowed to use the HICN to check the status of a claim (276 transactions, or within the IVR or portal) if the earliest FROM date of service on the claim is before January 1, 2020. If you are checking the status of a claim where all dates of service are on or after January 1, 2020, you must use the MBI.
How to Obtain the MBI:
- Ask your patients for their cards. If they did not get a new card, refer them to the Medicare.gov Your Medicare Card website.
- Use the MBI Lookup Tool in myCGS. Sign up for myCGS to use the tool.
Claim Submission when the MBI Changes:
The MBI may be changed due to a beneficiary or authorized representative request, or CMS may initiate the change.
Using the old or new MBIs in relation to claim submissions:
- Dates of service before the MBI change date – use the old or new MBI
- Span-date claims with a "From Date" before the MBI change date – use the old or new MBI
- Dates of service that are entirely on or after the effective date of the MBI change – use the new MBI
There are a few exceptions when you can use either the HICN or MBI on or after January 1, 2020:
- Appeals – You can use either HICNs or MBIs for claim appeals and related forms.
- Claim status query – You can use the HICN 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.
CGS Resources:
- myCGS MBI Lookup Tool
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Use myCGS to look up any Medicare beneficiary's MBI, regardless of where they live. To find MBIs in the portal, your Medicare beneficiaries must provide their first and last name, date of birth an SSN.
- DME Medicare Beneficiary Identifier (MBI) Converter for the IVR
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The Interactive Voice Response (IVR) system requires you enter your patient's name and Medicare number during the beneficiary validation process. Use this tool to convert the patient's MBI to the corresponding numbers on your telephone key pad.
- What to Do If the MBI Changes
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When checking eligibility using the myCGS portal or the Interactive Voice Response (IVR) and you receive error message "Invalid MBI", your patient's MBI may have changed.
Updated: 07.12.24