• Diego Loinaz-Martin

Summary of changes by the Centers for Medicare and Medicaid Services

In the interest of keeping you informed about events that may impact your business operations, we want to share with you a summary of changes being made by the Centers for Medicare and Medicaid Services (“CMS”).

Starting on January 1, 2020, the Social Security Number-based Health Insurance Claim Numbers (“HICNs) will be replaced in all Medicare beneficiary cards with a Medicare Beneficiary Identifier (MBIs). Therefore. any entity that submits Medicare transactions, such as billing, eligibility status and claim status, is on a transition period until December 31, 2019. The MBI is confidential and constitutes an identifier of Personally Identifiable Information, as defined by the Health Insurance, Portability and Accountability Act (“HIPAA”). In summary:


CMS has assigned an MBI’s to every Medicare Beneficiary.

  • Each MBI will be unique and randomly generated, MBIs do not have any secret meeting.

  • MBIs will be composed of 11 characters made only of numbers and uppercase letters.

Starting on January 1, 2020, all claims must be submitted using MBIs, regardless of the date on which the services were performed.


CMS has created the following exception to the new rule:

  • Appeals

  • Adjustments

  • Reports, such as Quality Reports, Provider Statistical & Reimbursement Reports, etc.

  • Retrospective Reporting

  • Audits

  • Claims Status Query – For claims submitted prior to January 1, 2020

  • Span-date claims

  • Incoming premium payments

The following link is the official publication by CMS on MBI’s, https://www.cms.gov/Medicare/New-Medicare-Card/index

As always, we are available at your convenience to answer any questions on the matter.

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