HICNs to MBIs for Medicare eligibility: How to handle the switch

By now, you are probably aware that the Centers for Medicare & Medicaid Services (CMS) is no longer accepting SSN-based Health Insurance Claim Numbers (HICNs) for most transactions.

The HICNs have been replaced with randomly-generated Medicare Beneficiary Identifiers (MBIs), intended to improve the security of patients’ personal information and help prevent fraud.

Starting January 1, claims or eligibility transactions submitted without an MBI have been rejected. And since an estimated 65 percent of claim denials are never corrected and re-submitted for reimbursement*, this could result in a preventable and sizeable hit to your revenue cycle.

The long and tedious hunt for patient MBIs

Updated Medicare cards with the new MBIs were mailed to patients long before the deadline, so one might expect the transition to be simple.

However, it’s important to remember that patients are people. They are busy. They forget to bring their cards to appointments. Especially where hospitals are concerned, patient visits may be unexpected or emergent. Where does that leave you as a provider?

While patient cards may be the easiest way to get an MBI, it certainly isn’t the only way. It’s possible to use your Medicare Administrative Contractor’s MBI look-up tool, but this process relies heavily on precise patient or policyholder data, and checking numbers one-at-a-time is tedious at best.

You can also refer to historical remittance advice if you happened to treat the patient prior to January 1 and have access to the records.

If you’ve had to resort to these methods, you understand how cumbersome the process can be.

An easier way to turn HICNs into MBIs

Busy healthcare providers need practical procedures to keep things running smoothly. Automated tools can take the administrative burden off of your staff and allow them to move on to the next claim faster.

Unlike other revenue cycle management providers, Inovalon goes beyond basic MBI lookup to provide full-service eligibility processing. Not only does our enhanced eligibility service have a nearly 100 percent MBI match rate; when combined with Eligibility Workflow, it also offers batch Medicare eligibility checks, alerts to indicate other insurance coverage and more.

Discover how to perform real-time eligibility verification and collect MBIs all at once. Request a demo today.

* Success in Proactive Denials Management and Prevention, Glen Reiner, HFMA, Accessed Jan 20, 2020, https://www.hfma.org/topics/hfm/2018/september/61778.html

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