Use Medicare Beneficiary Identifiers (MBIs): Claim Reject Codes Beginning January 1

As you all know, there was a transition in new Medicare cards where CMS replaced the SSN-based HICN with Medicare Beneficiary Identifiers (MBIs). We, at MPS, would like to encourage all practices to use MBIs for all Medicare transactions. Not only will it get you paid, but it will protect your patient’s identities. According to CMS, failing to use MIBs on claims will result in:

  • Electronic claims reject codes: 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”

Medicare will also start rejecting claims and all eligibility transactions submitted with Health Insurance Claim Numbers (HICNs).

As always, MPS is here for any questions. Please do not hesitate to contact us.