Prevent Medicare Claim Denials in 2020

Medicare Claim DenialsMedicare has been issuing beneficiaries new member cards with Medicare Beneficiary Identifiers (MBI) in place of Social Security Numbers (SSNs) for more than two years. 2019 was a phase-in period when Medicare would accept either a beneficiary’s Social Security Number or their new MBI on claims.

Starting Jan. 1, 2020, CMS will reject any Medicare claim Denials submitted with the SSN- based ID number for the beneficiary. A simple way to prevent claims denials is to make sure all your patients have their new card.

MBIs Required in 2020

The MBI phase-in period is complete, and all Medicare claim denials are expected to identify the beneficiary using their MBI. If the MBI is not used on claims after Jan. 1, the claim will be denied with one of the following reason codes:

  • Electronic claims reject codes: Medicare Claims Status 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 Medicare 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”

CMS says, to date, 87% of claims are submitted with the MBI. The other 13% of claims still using the SSN will be rejected and payment will not be received beginning Jan. 1, 2020.

If a patient does not know their MBI, you can look it up via the Medicare Administrative Contractor’s portal now and after the transition period. You can also find a patient’s MBI on the remittance advice.

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