Clients report issues with MBI Number for Medicare not matching the new card for a beneficiary

Date: December 27, 2019

Some practices have recently reported difficulty when searching Medicare beneficiary eligibility with the new Medicare Beneficiary Identifier (MBI) card #.  Some of the issues reported show that the MBI card shows differently in an eligibility search (they do not match).  Others have reported that after filing the claim, the claim is not paid because that particular MBI shows up as not valid for that beneficiary.

Most often, it turns out the MBI number for that beneficiary has been re-issued by CMS for a variety of reasons.  Denials of claims with an MBI that is incorrect are likely to show with a transaction error code of “AAA 72” or a similar type of error message.  Palmetto GBA issued an article on this subject last week with the following title: “MBI on a Patient’s Card Doesn’t Work?” You can link to that article here.  Even though this was posted on the Part A page by Palmetto, it applies equally to Part B services since the MBI is used for both Part A and Part B.  The article notes the following:

Remember, requests to change MBIs can occur if a Medicare beneficiary, their authorized representative, or CMS suspects a number is compromised. If CMS reissues MBIs, it is possible your patients will seek care before getting a new card with their new MBI.

If you get an eligibility transaction error code (AAA 72) of “invalid member ID,” or “The beneficiary you requested cannot be found. Please verify your information.” your patient’s MBI may have changed.

  • Do a historic eligibility search to get the termination date of the old MBI
  • Get the new MBI from your Medicare Administrative Contractor’s secure lookup tool. Sign up now! for the Portal to use the tool.

It’s probably a good idea to print out the MAC’s search result since it will show the new number; you can hand it to those affected so they can reach out to Medicare for a new card with the correct number.  Each Medicare Administrative Contractor (MAC) has created a secure portal for lookup of MBI.  Once on your MAC’s webpage, search for the following:  “Medicare Beneficiary Identifier (MBI) Lookup”.  Remember that all Medicare beneficiaries were issued new Medicare cards, and that use of the old number after Jan 1, 2020 – or incorrect MBI at any time – will result in a denial.  Here is a link to the general CMS MedLearn Matters on the new MBI and proper use; it is not specific to the issue with incorrect MBIs.

We are happy to assist groups and facilities with general claims issues and other coverage topics, which include: proper code selection, chart reviews and payer action questions. We provide training on these and other subjects. You can download our “App”, Corcoran 24/7 via one of the links below.

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