The Centers for Medicare and Medicaid Services (CMS) will be removing Social Security Numbers (SSNs) from all Medicare cards by April 2019. The change is part of an effort to protect Medicare beneficiaries from medical identify theft.
CMS began mailing new Medicare cards in Spring 2018 and expects that all new cards will be issued no later than April 2019. The nine-digit number Health Insurance Claim Number (HICN) that is currently listed on beneficiary cards will be replaced with a Medicare Beneficiary Identifier (MBI) that is 11 characters in length and made up of numbers and uppercase letters.
Pennsylvania is included in the first wave of new Medicare card mailings. In a press release issued on May 7, 2018, CMS announced that new Medicare cards have been mailed to beneficiaries in Pennsylvania, Delaware, DC, Maryland, Virginia, and West Virginia.
Your systems should be ready to accept the new numbers. Here are several things to keep in mind about the new cards:
- Patient Addresses—Offices should be verifying correct patient addresses now to ensure delivery of the new card starting next year. If the addresses you have on file are different than the Medicare address you get on electronic eligibility transactions, ask your patients to contact Social Security and update their Medicare records. You can let patients know they can update address information by:
- Visiting www.ssa.gov/myaccount
- Calling (800) 772-1213, TTY (800) 325-0778. Railroad Retirement Board (RRB) beneficiaries can call (877) 772-5772.
- Transition Period—There will be a transition period from April 1, 2018, until Dec. 31, 2019, during which both the HICN or MBI numbers will be accepted. Once the transition period ends, you must use the MBI, with these exceptions:
- Appeals: Use either number
- Adjustments: Use the HICN indefinitely
- Reports: HICN used until further notice
- Provider Portal Lookup Tool—Starting in June 2018, you can look up your patients' new Medicare numbers through your Medicare Administrative Contractor's (MAC) secure web portal if your patient is unable to provide his/her card. In Pennsylvania, the MBI Lookup Tool will be available through the Novitasphere portal. The portal will require patient first and last name, date of birth, and SSN.
- Electronic Health Record System Updates and Testing—Practices should find out whether they need to make updates to their EHR systems. Consider the following:
- Make sure your EHR can accept the new MBI. Use these MBI format specifications if you currently have edits on the current Health Insurance Claim Number (HICN).
- Identify your patients who qualify for Medicare under the RRB. You will no longer be able to distinguish RRB patients by the number on the new Medicare card. You will be able to identify them by the RRB logo on their card, and CMS will return a message on the eligibility transaction response for a RRB patient. The message will say, "Railroad Retirement Medicare Beneficiary" in 271 Loop 2110C, Segment MSG. If you use the number only to identify your RRB patients beginning in April 2018, you must identify them differently to send Medicare claims to the RRB Specialty Medicare Administrative Contractor, Palmetto GBA.
- Update your practice management system's patient numbers to automatically accept the new Medicare number or MBI from the remittance advice (835) transaction. Beginning in October 2018, through the transition period, CMS will return your patient's MBI on every electronic remittance advice for claims you submit with a valid and active HICN. It will be in the same place you currently get the "changed HICN": 835 Loop 2100, Segment NM1 (Corrected Patient/Insured Name), Field NM109 (Identification Code).
- If you’ve made system changes, test those changes and work with your billing office staff to make sure you’re ready to use the new MBI format.
- Spouse's Medicare Cards—The Medicare cards of spouses will no longer look similar, as they have in the past.
- Beneficiary Identifier on Remittance Advice—Beginning October 2018 through the end of the transition period, when a valid and active HICN is submitted on Medicare FFS claims, both the HICN and the MBI will be returned on the remittance advice.
CMS offers a wide variety of resources that can help practices and patients navigate the transition to new Medicare cards, including:
Pennsylvania Medical Society members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.