Medicare Social Security Number Removal Initiative

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019.

A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status.

CMS currently uses an SSN-based HICN to identify people with Medicare and administer the program. CMS uses the HICN with business partners like:

Under the new system, for each person enrolled in Medicare, CMS will:

  • Assign a new MBI.
  • Mail a new Medicare card.

The MBI is confidential like an SSN, thus, it should be protected as Personally Identifiable Information.

What are the key dates?

  • April 1, 2018 - Medicare will begin issuing MBI cards. 
  • July 1, 2018 - Provider lookup tool available for MBI/HICN cross-reference.
  • October 1, 2018 - Remittances will reflect MBI number.
  • January 1, 2020 - Only MBI numbers accepted on claims.

What are we changing in the WebPT EMR to accommodate the new MBI number?

The changes to the EMR will be made to the Policy Information screen when adding or editing an insurance in the patient chart.

For Medicare insurance types, the HCIN field will be renamed “MBI/HCIN”.  As is the case now, an entry in that field will be required in order to save the patient.  During the transition period, either the HCIN or MBI can be entered.

For existing patients, there will now be a link to the Change Log displayed when the value in the field is modified; displaying a log of past entries in that field, along with the date of the change.

Further, the entry in the log (the old HICN) can be selected and made ‘active’ as the Medicare Policy number again by clicking the checkbox on the right, then selecting update.

This functionality allows the user to modify that field while not losing the history of entries and reusing those entries if needed.

Inbound/Outbound MBI

Members with an inbound patient integration will see an additional policy added to the patient the first time the patient’s new MBI is sent to the integration.  That policy will have the MBI number entered in the same field as the HICN. If cases are being created or updated through the integration, any cases with the old HICN policy will be updated to use the new MBI policy.  If cases are being created manually, the member will need to edit any cases using the HICN policy and assign the new MBI policy.

Members using an outbound billing integration will see the MBI number being sent in the same place as the HICN is currently sent.

FAQ

How is it different from HICN?

The MBI has the same number of characters as the current HICN—which is 11—but will be visibly distinguishable from the HICN; containing uppercase alphabetic and numeric characters. It will occupy the same field as the HICN on transactions.

The biggest difference is that it will be unique to each beneficiary. For example, a husband and wife will have their own MBI.

The MBI will be easy to read and limit the possibilities of letters being interpreted as numbers. The alphabetic characters are uppercase only and will exclude the letters S, L, O, I, B and Z. The MBI will also not contain any embedded intelligence or special characters, nor will it contain any inappropriate combinations of numbers or strings that may be offensive.

CMS anticipates that the MBI will not be changed for the individual, unless the MBI has been compromised, or for other limited circumstances that are still under review.

When does it start?

The transition period will be April 1, 2018, through December 31, 2019; during which, CMS will accept and process both the HICN and MBI on medical claims.

CMS anticipates mailing the first cards starting on April 1, 2018, and finishing through May 31, 2019. CMS anticipates that system and process updates will be ready to accept and return to MBI as of April 1, 2018. All stakeholders who submit or received transactions containing the HICN must modify their processes and systems to be ready to submit or exchange to MBI by April 1, 2018, to coincide with the first card mailings. As previously mentioned, stakeholders may submit either the MBI or HICN during the transition period. In addition, beginning on October 1, 2018, through the end of the transition period when a valid and active HICN is submitted on the Medicare fee for service claims, both the HICN and MBI will be returned on the remittance advice. And as I stated previously, the transition period will run from April of 2018 through December 31st of 2018.

How long will the transition to MBI last?

All beneficiaries should have a new MBI Number by May 31, 2019. As of December 31, 2019, the HICN will no longer be utilized for processing beneficiary claims or exchanged with other payers.  There are some exceptions.

What happens on the claim after an MBI is entered into the EMR?

It will be the patient identifier on the Daily Note and should be utilized on the 1500 claim form going forward when billing Medicare.

What happens in the snapshot for Members with integrated billing once the MBI is entered into the EMR?

The MBI number will replace the HCIN in the snapshot sent to the billing system.  It basically functions as if a policy number change for the patient’s payer was made on the payer screen.

Will the HICN be needed anymore?

Until January 1, 2020, either the MBI or the HCIN will be recognized by Medicare.  Afterward, there are some exceptions where the HCIN could be needed. WebPT has created a change log for easy access to both assigned numbers and either can be active in the patient’s chart.

When will a claim be denied because it doesn’t reference the patient’s MBI number?

January 1, 2020.  Until then either number can be used on the patient’s claims without risk of a denial.

Additional Resources Resources