Claim submission with new Medicare cards

CMS recently released guidance on submitting claims and filing appeals as it rolls out its new Medicare cards. The new cards will replace the Health Insurance Claim Number (HICN), which is based on the beneficiary’s Social Security Number (SSN), with a Medicare Beneficiary Identifier (MBI) that is not tied to the beneficiary’s SSN.

This move is intended to help protect beneficiaries’ SSNs. Medicare will begin rolling out the new cards in April 2018 by geographic region. However, it has until April 2019 to ensure that all beneficiaries have received their cards, during which time facilities must follow CMS guidance regarding whether to use the HICN or MBI when submitting claims and appeals. 

With some exceptions, facilities can use either the HICN or MBI to exchange data with CMS from April 1, 2018, through December 31, 2019. Regardless of the date of service, all claims submitted after January 1, 2020, must use the MBI.

Medicare plan exceptions state that facilities can use either the HICN or MBI for claims appeals and related forms. The HICN can be used indefinitely for some systems (e.g., drug data processing, risk adjustment processing, encounter data). CMS will use the HICN on incoming and outgoing reports until further notice.

Fee-for-service claim exceptions state that facilities can use either the HICN or MBI for appeals and to check the status of claims with a date of service prior to January 1, 2020. For span date claims, the HICN can be used on 11X, 32X, and 41X claims with from dates prior to January 1, 2020. For these claim types, if the patient begins services prior to December 31, 2019, and continues receiving those services after December 31, 2019, the claim can use the HICN or MBI even if the claim is submitted after December 31, 2019. Claims received from April 1, 2018, through December 21, 2019, can use either the HICN or MBI. Claims for beneficiaries who do not receive Social Security or Railroad Retirement Board benefits but who submit premium payments should include the use of the MBI on incoming premium remittances. However, CMS will still accept the HICN on incoming premium remittances after the transition period ends December 31, 2019.