Why is CMS issuing new Medicare cards and new Medicare numbers?
The law requires the Centers for Medicare & Medicaid Services (CMS) to remove Social Security
numbers (SSNs) from all Medicare cards by April 2019. A new unique Medicare number will replace
the current Health Insurance Claim Number (HICN) on the new Medicare cards. We’re taking this
step to protect people with Medicare from fraudulent use of Social Security numbers, which can lead
to identity theft and illegal use of Medicare benefits.
When will CMS mail the new cards to people with Medicare?
We’ll begin mailing new cards in April 2018 and will meet the statutory deadline for replacing all Medicare cards by April 2019. Your patients who are new to the Medicare program starting in April 2018 and later will only have a card with the new Medicare number.
What do I need to be ready for the change?
Your systems and business processes must be ready to accept the new Medicare number (which we call the Medicare Beneficiary Identifier or MBI in official guidance) by April 2018 for transactions,
such as billing, claim status, eligibility status, and interactions, with our Medicare Administrative
Contractor (MAC) contact centers. There will be a transition period when you can use either the HICN or the MBI to exchange data and information with us.
The transition period will start April 1, 2018, and run through December 31, 2019. However, your systems must be ready to accept the new MBI by April 1, 2018. It’s especially important that you’re ready for people who are new to Medicare in April 2018 and later because they’ll only get a card with the MBI.
How will the MBI look?
The MBI format is still 11 characters long, contains numbers and uppercase letters, and is unique to
each person with Medicare. It will be clearly different from the HICN.
How many characters will the MBI have?
The MBI has 11 characters, like the Health Insurance Claim Number (HICN), which can have up to 11.
Will the MBI’s characters have any meaning?
Each MBI is randomly generated. This makes MBIs different than HICNs, which are based on the
Social Security Numbers (SSNs) of people with Medicare. The MBI’s characters are “non-intelligent”
so they don’t have any hidden or special meaning.
What kinds of characters will be used in the MBI?
MBIs are numbers and upper-case letters. We’ll use numbers 0-9 and all letters from A to Z, except
for S, L, O, I, B, and Z. This will help the characters be easier to read.
How will the MBI look on the new card?
The MBI will contain letters and numbers. Here’s an example: 1EG4-TE5-MK73
● The MBI’s 2nd, 5th, 8th, and 9th characters will always be a letter.
● Characters 1, 4, 7, 10, and 11 will always be a number.
● The 3rd and 6th characters will be a letter or a number.
● The dashes aren’t used as part of the MBI. They won’t be entered into computer systems or used
in file formats.
Who will get a new MBI?
Each person with Medicare will get their own randomly-generated MBI. Spouses or dependents who
may have had similar HICNs will each get their own different MBI.
What about Medicare Advantage and Prescription Drug plans?
Medicare Advantage and Prescription Drug plans will continue to assign and use their own identifiers
on their health insurance cards. For patients in these plans, continue to ask for and use the plans’
health insurance cards.
How do I use the MBI?
You’ll use the MBI the same way you use the HICN today. During the transition period, on all transactions, you can use either the HICN or the MBI in the same field where you’ve always put the HICN. You don’t need to say whether you’re using a HICN or MBI because our systems will be able to tell which you’ve used. You cannot submit both numbers on the same transaction. Once the transition period ends, you must use the MBI in the same field where you previously submitted the HICN.
What about Medicare crossover claims?
We are working closely with other payers, State Medicaid Agencies, and supplemental insurers to
make sure the crossover claims process will still work like it does now. During the transition period,
we’ll process and transmit Medicare crossover claims to other health insurance organizations with
either the HICN or MBI.
Do I need to protect the MBI?
The MBI is confidential just like the HICN so you’ll have to protect it as Personally Identifiable
Information and use it only for Medicare-related business.
What happens after the transition period ends?
On January 1, 2020, even for dates of services prior to this date, you must use MBIs for all transactions; there are a few exceptions when you can use either the HICN or MBI:
● Appeals
– You can use either the HICN or MBI for claim appeals and related forms.
● Claim status query
– You can use HICNs or MBIs 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 HICN for 11X-Inpatient Hospital, 32X-Home Health, and 41X-Religious Non-Medical Health Care Institution claims if the “From Date” is before the end of the transition period (December 31, 2019). You can submit claims received between April 1, 2018, and December 31, 2019, using the HICN or the MBI. 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 HICN or the MBI, even if you submit it after December 31, 2019.
● Home Health Claims and Requests for Anticipated Payments (RAPs)
– You can use MBIs or HICNs on home health claims and RAPs with a “From Date” before January 1, 2020. Because you submit home health claims for a 60-day payment episode, there may be times when an
episode ends after the transition period on December 31, 2019. If the “From Date” on the RAP
or the final claim date is before December 31, 2019, you may submit either the HICN or the MBI.
But, you must submit the MBI for RAPs and final claims when the “From Date” is on or after
January 1, 2020.
When will CMS share information with the public about the new Medicare card design and the
mailing schedule?
We will share information about the new card design in September 2017. The gender and signature
line will be removed from the new cards. There will be geographical waves of successive mailings.
Mailing everyone a new card will take some time. To protect people with Medicare from scams
associated with sharing the mailing schedule, targeted local outreach will occur, including outreach to
health care providers, before cards are due to arrive in a geographical area.
Where can I get more information?
Visit our New Medicare Card Home and Provider webpages for the latest details about the transition
at: www.cms.gov/Medicare/New-Medicare-Card
