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Avoid Rejections On January 1, 2020 By Using The MBI!

From the Desk of Ronda Buhrmester:

Medicare has gone to Medicare Beneficiary Identifier (MBI) from HICN that appeared on a beneficiary’s Medicare card.  The transition started in April 2018 being implemented into various phases across the country. 

The transition period will end Dec. 31, 2019.  The MBI is required on any eligibility requests, claim submissions, prior authorization requests, and reopening requests to Medicare starting January 1, 2020.  If the claim is not using the MBI starting January 1, the claim will be rejected.  These are the reject codes that a supplier will receive for either an electronic claim or paper claim:

    - Electronic claims reject codes: Claims Status Category Code of A7 (acknowledgment rejected for invalid information), a Claims Status Code of 164 (entity's contract/member number), and an Entity Code of IL (subscriber)

    - Paper claims notices: Claim Adjustment Reason Code (CARC) 16 "Claim/service lacks information or has submission/billing error(s)" and Remittance Advice Remark Code (RARC) N382 "Missing/incomplete/invalid patient identifier"

The DME MACs will not correct, the supplier is required to make the correction.   This means it would need to be corrected and resubmitted. 

To avoid the rejection, start using the MBI now!

Here are links to CGS and Noridian’s websites for more information.



Ronda Buhrmester

Senior Director of Payer Relations & Reimbursement

[email protected]