Provider/Supplier Obtaining/Verifying the Medicare beneficiary

30 - Provider/Supplier Obtaining/Verifying the Medicare beneficiary identifier and Entitlement Status (Rev. 4247, Issued: 03-01-19, Effective: 04-01-19, Implementation: 04-01 -19) The term Medicare beneficiary identifier (Mbi) is a general term describing a beneficiary's Medicare identification number. For purposes of this manual, Medicare beneficiary identifier references both the Health Insurance Claim Number (HICN) and the Medicare Beneficiary Identifier (MBI) during the new Medicare card transition period and after for certain business areas that will continue to use the HICN as part of their processes. It is important that the patient’s Medicare beneficiary identifier be obtained and accurately recorded because the claim cannot be processed if the Medicare beneficiary identifier is missing or incorrect. A social security number is not sufficient. When a patient 65 years of age or over, or a younger patient who possibly has entitlement to Medicare as a disability beneficiary or under the provisions for coverage of persons needing a kidney transplantation or dialysis, is admitted or registered for services, the provider asks for the health insurance card, Temporary Notice of Medicare Eligibility, or other notice the patient has received from CMS or an A/B MAC (A), (B), (HHH), or DME MAC which shows the Medicare beneficiary identifier. If a patient or prospective patient is within three months of age 65, or is disabled or has ESRD, and has not applied for HI entitlement, the provider advises the patient to contact the SSO, or to have someone do so on the patient’s behalf. The provider may arrange with the SSO to routinely bring such cases to the SSO’s attention. This requirement also applies to inpatient services for which no payment is due because providers are required to submit inpatient claims even when benefits are exhausted or are not payable for some reason. The CMS requires this data to record necessary benefit information on CMS records. Where the patient refuses to request payment and refuses to furnish information about his/her Medicare beneficiary identifier, the provider documents the records accordingly and attempts to get the Medicare beneficiary identifier from the SSO.