How do health care providers & office managers use MBIs?

Medicare Beneficiary Identifiers (MBIs) are confidential

MBIs are Personally Identifiable Information. You must protect MBIs and only share them for Medicare-related business.

Checking eligibility

You must use the MBI to check eligibility.

Railroad Retirement Board (RRB) beneficiaries

We tell you in the message segment of the HETs eligibility transaction response if your patient's eligible for Medicare under the RRB benefit. The message says, "Railroad Retirement Medicare Beneficiary."

271 Loop 2110C, Segment MSG

You can’t tell from looking at the MBI if your patients are eligible for Medicare because they’re railroad retirees. Identify RRB patients based on the image of the card (RRB logo in the upper left corner, and "Railroad Retirement Board" at the bottom), and send those claims to the Specialty Medicare Administrative Contractor (SMAC).

Using qualifiers

For ASC X12N transactions, we use the Member Identification Number (MI) Identification Code Qualifier as follows:

• ASC X12N 270/271: Loop 2110C, NM1 – Subscriber Name Segment, NM108  - Identification Code Qualifier Element Detail
• ASC X12N 276/277: Loop 2100D, NM1 – Subscriber Name Segment, NM108 – Identification Code Qualifier Element Detail
• ASC X12N 835: Loop 2100, NM1 – Patient Name Segment , NM108 – Identification Code Qualifier Element Detail
• ASC X12N 837 I and P : Loop 2010BA, NM1 – Subscriber Name Segment, NM108 – Identification Code Qualifier Element Detail
• ASC X12N 278: Loop 2010C, NM1 – Subscriber Name Segment, NM108 – Identification Code Qualifier Element Detail

Reporting relationship to insured

Because each MBI is randomly generated and unique to each person with Medicare, on claims, you'll report SELF as the relationship to the insured.

On the UB-04:

FL 59      Patient’s Relationship to Insured (Loop 20008) (SBR02):

18           Self

On the Paper Claim 1500:

FL 6        Patient’s Relationship to Insured (Loop 20008 2000C) (SBR02):

Self

How do I use the MBI for informational only & no-pay claims?

You must submit informational only and no-pay claims using the MBI in Loop 2010BA, NM1 – Subscriber Name Segment, NM109 (Identification Code for both 837I & P).

Electronic or paper transactions

The remittance advice will tell you if claims are rejected because they don’t use an MBI or if they’re rejected or denied for other reasons. If your claims are rejected because you didn’t use the MBI, get the MBI from your patient and follow existing procedures to correct and resubmit rejected claims.

Episode claims

How should I submit Home Health (HH) claims with episodes that end after MBIs started being used?

You must use MBIs on HH claims and Requests for Anticipated Payment (RAPs) with a through date on or after January 1, 2020. Since you submit HH claims for a 60-day payment episode, there may be times when an episode ends after we start using the MBIs. If this happens, you can send in the episode’s RAP with either the HICN or the MBI, but you have to use the MBI when you send in the claim that goes with it.

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