New beginnings: medicare mbi
Beginning January 1st 2020, Centers for Medicare and Medicaid Services (CMS) stopped accepting HICN (SSN-based Member ID) and now require the Medicare Beneficiary Identifier (MBI) for all Eligibility Verification, Claim Submission, reopening requests, and prior authorization requests. Not only do the outdated HIC Numbers no longer work, but CMS has also removed Social Security Numbers from the Medicare ID Cards as well. The MBI doesn’t change Medicare benefits (MBI is considered Personally Identifiable Information (PII), it is confidential.)
How can you look up a Medicare MBI ID?
There are a few ways to find a patient’s new MBI ID.
- A patient’s new Medicare ID Card
- Directly from the myCMS Portal (one patient at a time)
- Third-Party Software such as pVerify.
What patient information do you need to look up an MBI ID?
- Full name
- Date of birth
- Social Security Number
Are there any restrictions to who can look up an MBI ID?
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Only Medical Professionals and certain types of non-physician practitioners have access to CMS’s MBI Lookup tool. (Doctor of medicine or osteopathy, dental, podiatric, optometry, Physician assistant, Certified clinical nurse specialist, Nurse practitioner, Clinical psychologist, Certified nurse-midwife, and Clinical social worker.)
What if I am not a Medical Professional or one of the providers above?
- Third Party Software companies, like pVerify, allow consumers in multiple industries to user their MBI Lookup Tools. With pVerify’s MBI Lookup Tool NPIs, PTANs, and Tax IDs are not required.
Choosing the solution that’s right for you
It is now imperative for you to use Medicare’s new MBI for all transactions.
Schedule an MBI Focused ZOOM Meeting
Batch Record MBI Processing and Individual Patient Lookup meeting available upon request.
pVerify has 3 simple solutions to acquire a patient’s new ID.
MBI Through API
MBI API is a near real-time MBI Lookup coded into your website or software that provides a patient’s new MBI ID without manual oversight or involvement.
Batch Record MBI Processing
Available with integrations or stand-alone, Batch Record Processing provides the new MBI IDs in large batches of patients, most commonly provided in an Excel Format
Individual Patient Lookup
Located directly on pVerify’s web portal, users can look up each patient’s MBI ID on an as-needed basis.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) required CMS to remove SSNs from all Medicare cards. CMS replaced the SSN-based HICN with a new, randomly generated MBI. The MBI hyphens on the card are for illustration purposes: don’t include the hyphens or spaces on transactions. The MBI uses numbers 0-9 and all uppercase letters except for S, L, O, I, B, and Z. We exclude these letters to avoid confusion when differentiating some letters and numbers (for example, between “0” and “O”). Review the MBI specifications format here: https://www.cms.gov/Medicare/New-Medicare-Card/Understanding-the-MBI.pdf
About pVerify:
Founded in 2006, pVerify has evolved from an eligibility service vendor to a one-of-a-kind solution software. pVerify delivers unique Eligibility & Benefits Results (customized to individual Specialty and Practice needs) available on our cloud-based portal, integration with many EMR/PMs, and API integration. Our capabilities expand far beyond standard clearinghouses. As a small entity in the industry we are able to focus on development and enhancements, both to the evolution of the eligibility verification and the interests of our clients. It was the foreseen need of our clients that compelled us to develop the MBI Lookup Feature in late 2019. Since it first launched on January 1st, 2020 we have expanded from the single patient format, to batch processing, and finally to API. As of April 30th, 2020 pVerify has completed over 157,000 MBI ID Lookups.