New Medicare Cards and Patient Identifiers

We are pleased to announce enhancements to ABILITY applications in support of the transition to new Medicare numbers and cards, as required by law. The Centers for Medicare and Medicaid Services (CMS) will remove Social Security numbers from all Medicare cards between April 1, 2018 and April 2019 in a phased rollout. A unique Medicare patient identifier (MBI) will replace the current Health Insurance Claim Number (HICN) on beneficiary cards, as well as for billing and other patient-related purposes.

CMS is taking this step to reduce fraud in accessing Medicare benefits and to protect Medicare beneficiaries from identity theft.

The following updates to ABILITY applications will support this change:

ACCESS DDE
ACCESS DDE API+

Schema changes will be made to support the use of the MBI. The changes will be retroactive from the customer standpoint, so that when using the HICN, no changes will be required of them. Customers should consult the updated schema if they wish to use the MBI instead of the HICN

IVANS Now
ACCESS DDE

The field within Common Working File has been updated to support the MBI and renamed HIC/MBI Number as shown below:

Click to enlarge

ABILITY | AUTOMATE esMD

There will be no impact to customers using these applications. There is no MBI / HICN relevant to these transactions.

ABILITY | EASE All-Payer

The MBI transition will be seamless for EASE All-Payer customers. ABILITY | EASE All-Payer processes claims for 3,000+ payers and supports each payer’s distinct member ID format. Customers will be able to process Medicare claims using the new MBI without interruption to their service. Customers may continue to use the HICN through the transition period if they prefer. Customers should note that if they use the MBI or HICN as search criteria when using the Patient Search feature, the results will only display claims submitting with that ID. Customers should consider using name and/or patient control number in searches to avoid this.

ABILITY | EASE Medicare

EASE Medicare is prepared to support MBI updates before the transition begins April 1.

EASE will “read” and return both the MBI and HICN as listed in the Common Working File.

All EASE reports, eligibility and claims workflow will include either the MBI or HICN as shown in the Common Working File.

ABILITY | CAREWATCH

ABILITY | UBWATCH

eHDS

Updated MBI functionality will be in place before the April transition, as part of the Release 2.2.2, targeted for Feb. 22, 2018.
The new MBI will populate into the existing Medicare Number field on the MDS (A0600B), and in the existing field locator (FL 51) on the UB04.

  • WATCH products will accept and process both the legacy HICN and new MBI formats for MDS assessments and UB04 claims.

ACCESS All-Payer Eligibility

ACCESS Medicare Eligibility

EligibilityONE

If an eligibility request is sent with a HICN for a beneficiary who has already been assigned an MBI, the following will happen:

  • The request will process successfully even though the HICN was used.
  • The response will include an MSG segment notifying the provider that the beneficiary has been assigned an MBI. This allows the provider to collect that information from the beneficiary and update provider records.
  • The CMS HETS 270 / 271 Release Summary Document is available.

ABILITY | CHOICE Medicare Claims

There will be no impact to customers using these applications. There is no MBI / HICN relevant to these transactions.

ABILITY | CHOICE Medicare Eligibility

If an eligibility request is sent with a HICN for a beneficiary who has already been assigned an MBI, the following will happen:

  • The request will process successfully even though the HICN was used.
  • The response will include an MSG segment notifying the provider that the beneficiary has been assigned an MBI. This allows the provider to collect that information from the beneficiary and update provider records.

ABILITY | CHOICE All-Payer Claims

The MBI transition will be fairly seamless for customers using the CHOICE application. ABILITY | CHOICE All-Payer Claims is designed to process claims for 3,000+ payers, supporting each of their distinct member ID formats. Customers will be able to process Medicare claims using the new MBI without interruption of their service. They may continue to use the HICN throughout the transition period if preferred. When using the Patient Search feature in CHOICE, the application will display only claims that relate to the identifier used in the search. For this reason, customers should consider using the patient name and/or control number to effectively display all relevant claims.

ABILITY | CHOICE Patient Statements

Not applicable. There will be no impact to customers.

ABILITY | COMPLETE

If an eligibility request is sent with a HICN for a beneficiary who has already been assigned an MBI, the following will happen:

  • The request will process successfully even though the HICN was used.
  • The response will include an MSG segment notifying the provider that the beneficiary has been assigned an MBI. This allows the provider to collect that information from the beneficiary and update provider records.

ABILITY | INSIGHT

No anticipated impact to INSIGHT reports. The ABILITY analytics infrastructure will automatically tie together claims for the same individual regardless of whether they are submitted with a HICN or MBI.

ABILITY | OPTIMIZE

The MBI will populate into the existing Medicare Number field on the OASIS (M0063) and the existing field locator (FL 51) on the UB04. OPTIMIZE will accept and process both the legacy (HICN) and new (MBI) formats for OASIS assessments and 837 EDI files. Updated MBI functionality will be in place as part of Release 2.2.1, targeted for Feb. 27, 2018.

ABILITY | PC-ACE

PC-ACE has been updated to accept both the HICN and MBI identifiers on Medicare claims. PC-ACE will continue to support both values until the HICN is phased out.

SES / SEAPI

SES / SEAPI file transfer processes are not impacted by the introduction of MBI. No changes are required to current integrations. After April 1, CMS will be able to process EDI files that feature either HICN or MBI identifiers. Customers should update their EDI applications in accordance with the relevant MAC Companion Guide.

These enhancements represent our ongoing commitment to supporting customer compliance with CMS and other regulatory requirements. If you have further questions, please contact your Customer Support representative.