The New Medicare Card Project, which was established in the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015, requires the Centers for Medicare & Medicaid Services (CMS) to remove Social Security numbers (SSNs) from all Medicare cards by April 2019. CMS will issue new Medicare cards that will feature a Medicare Beneficiary Identifier (MBI) in place of the SSN-based Health Insurance Claim Number (HICN), which is used to track Medicare billing, eligibility status, and claim status.
Why is CMS issuing new Medicare cards?
In addition to meeting a requirement mandated by statute, CMS is issuing new Medicare cards to combat identity theft and illegal use of Medicare benefits. The new Medicare cards will feature the MBI, which is a randomly assigned number integral to this fraud-prevention effort.
MBIs will comprise a mix of 11 uppercase alphabetic and numeric characters. The second, fifth, eighth, and ninth characters of the MBI will always be alphabetic. The use of several alphabetic characters makes MBIs visibly distinguishable from HICNs, which are primarily numeric.
Unlike HICNs, which list patients’ SSNs, MBIs are generated as “non-intelligent” unique identifiers, so they do not have any special meaning specific to beneficiaries. Although MBIs are “non-intelligent,” they are still confidential identifiers and should be used only for Medicare-related business.
How does CMS plan to implement the New Medicare Card Project?
CMS has a three-step plan to execute the New Medicare Card Project:
- Generate MBIs for all beneficiaries. MBIs will be assigned to existing (active, deceased, or archived) and new beneficiaries.
- Educate stakeholders and distribute new Medicare cards. CMS will mail the new Medicare cards in geographical waves. CMS will conduct targeted local outreach to patients, caregivers, and providers before the new cards are due to arrive in a geographical area.
- Modify the systems and business processes. CMS will provide regular updates to accommodate receipt, transmission, display, and processing of the newly assigned MBI.
What is the timeline for the New Medicare Card Project?
CMS will begin mailing the new cards in April 2018 and will replace all old Medicare cards by April 2019. To help practices successfully convert to the MBI system, CMS will offer a transition period, beginning April 1, 2018, and ending December 31, 2019, during which providers will be allowed to submit either the HICN or MBI when billing Medicare. Providers should not submit both numbers on the same transaction.
After the 21-month transition period, CMS will not accept claims that include HICNs. CMS requires that all providers who submit or receive Medicare transactions containing HICNs modify their processes and electronic systems and be ready to accept MBIs by April 1, 2018.
While providers must use MBIs after December 31, 2019, HICNs may still be used in the following Medicare transactions:
- Claims appeals: CMS will accept appeals requests and related forms that contain either a HICN or MBI.
- Claims status queries: Providers can use either HICNs or MBIs to check the status of a claim with a date of service on or before December 31, 2019.
- Span-date claims: Providers can submit claims using either the HICN or MBI for patients who began receiving services in an inpatient hospital, home health, or religious nonmedical health care institution before December 31, 2019, but stop receiving such services after December 31, 2019.
Will these new Medicare cards affect Medicare benefits?
No, the new Medicare cards and MBIs will not affect the benefits that a Medicare beneficiary receives.
What resources will be available for providers to look up patient MBIs?
Starting in April 2018, when providers input a HICN into the HIPAA (Health Insurance Portability and Accountability Act) Eligibility Transaction System (also known as HETS) to check a patient’s Medicare eligibility status, the system will indicate whether CMS has mailed a new Medicare card to the beneficiary. CMS will begin including both the HICN and MBI on every claims processing decision sent to providers in October 2018.
In June 2018, CMS will release an MBI look-up tool in Medicare Administrative Contractor (MAC) secure web portals that will allow providers to look up MBIs for Medicare beneficiaries. To find a beneficiary’s MBI in the MAC portal, providers must know the patient’s first name, last name, date of birth, and SSN. This tool is intended for providers to be able to access a beneficiary’s MBI at the point of service without disrupting the clinical workflow. CMS encourages practices to subscribe to their MAC’s portal to ensure that providers have a mechanism to access patients’ MBIs. CMS has created a list of MAC websites (www.cms.gov/Medicare/New-Medicare-Card/Providers/MACs-Provider-Portals-by-State.pdf) to help providers locate their MAC’s portal.
What steps can providers take to prepare for the new Medicare cards?
- Visit the CMS provider website and sign up for the weekly Medicare Learning Network (MLN) Connects newsletter to receive updates on the New Medicare Card Project.
- Participate in CMS quarterly calls to get additional New Medicare Card Project information. CMS will let providers know when calls are scheduled in MLN Connects.
- Verify all Medicare patient addresses. If the addresses on file are different from the addresses listed on electronic eligibility transactions, providers should ask patients to contact the Social Security Administration and update their Medicare records, which may require coordinating between billing and office staff.
- Work with CMS to help Medicare patients adjust to their new Medicare cards. CMS will produce posters and other educational materials that providers can share with patients to educate them about New Medicare Card Project-related changes.
- Prepare to use the new MBI format by asking billing and office staff to ensure that the practice management systems being used can accept the 11-character alphanumeric MBI. In addition, providers should confirm that vendors used to bill Medicare are ready for the change.
Where can I go for more information or questions on the New Medicare Card Project?
More information about the New Medicare Card Project is available on the CMS website.
Surgeons who have questions about complying with the New Medicare Card Project may contact CMS at NewMedicareCardSSNRemoval@cms.hhs.gov, or the American College of Surgeons Division of Advocacy and Healthy Policy at firstname.lastname@example.org.