Changes coming to Medicare beneficiary numbers
Beginning in 2018, CMS will replace the Medicare Health Insurance Claim Number (HICN) with a new identifier called a Medicare Beneficiary Identifier (MBI) to meet the requirements of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. CMS has planned a transition period from April 1, 2018 to December 31, 2019 for submitting the MBI number on claims.
Here are some of the milestones of this transition:
- January 2018: CMS will generate 150 million MBIs, 60 million for active beneficiaries and 90 million deceased or archived beneficiaries.
- April 2018 to July 2019: New and active enrollees will receive new Medicare cards with MBIs rather than HICNs.
- April 2018 to December 2019: Providers may submit claims and data with either the patient's HICN or MBI. We recommend using the MBI as soon as possible.
- October 2018 to December 2019: When a valid and active HICN is submitted on a Medicare claim, the HICN and the MBI will be returned on the Medicare remittance advice.
Note: The transition to the MBI will not affect our Regence member numbers or cards. Please continue to submit the Regence member number on claims for our members.
Please check with your software vendors and clearinghouses to make sure you are ready for this transition.
CMS has included detailed information about the transition and MBI format guides on their website.
Medicare is primary
When Medicare is the primary payer for an out-of-area member (e.g., Medigap plans), follow these procedures:
Submit claims to your local Medicare contractor first. Do not send the claim to Medicare and the supplemental insurer simultaneously.
Be sure to include the:
- Patient's complete member number
- Patient's name as it appears on the member ID card
- Complete Health Insurance Claim Number (HICN)
Other payer's name and address (OCNA) number. If you include this information, make sure it is the correct OCNA for the member's Blue Plan.
After you receive the Explanation of Medical Benefits (EOMB) or payment advice from Medicare, determine if the claim was automatically crossed over to the supplemental insurer:
- Crossed over: If the indicator on the EOMB or payment advice shows that the claim was crossed-over (claim status code 19: "Medicare paid primary and the Intermediary sent the claim to another insurer"), Medicare has forwarded the claim on your behalf to the appropriate Blue Plan and the claim is in process. You do not need to file for the Medicare supplemental benefits. The Medicare supplemental insurer will automatically pay you if you accepted Medicare assignment. Otherwise, the member will be paid and you will need to bill the member.
- Not crossed over: If the indicator on the EOMB or payment advice does not indicate the claim was crossed over (claim status code 1: "Paid as primary" may appear; claim status 19 will not appear), file the claim and the payment advice to Regence. Regence or the member's Blue Plan will pay you the Medicare supplemental benefits. If you did not accept Medicare assignment, the member will be paid and you will need to bill the member. If the Medicare EOMB does not reflect that the claim was crossed for supplemental payment, you must wait 30 days from the Medicare EOMB date to submit the claim to Regence.
Blue Plan is primary
When a Blue Plan is the primary payer (e.g., Medicare Advantage), submit claims to Regence. Do not bill Medicare directly for any services rendered to a Medicare Advantage member.
Learn more about reimbursement for services to these members.