Why Medicare Uses A Claim Number
Medicare once used a beneficiarys Social Security number to file claims. But the Medicare program loses billions of dollars to fraud every year, and using a persons Social Security number makes it easier for people who commit fraud to steal identities and abuse Medicare benefits.
To help remedy the problem of Medicare fraud, the Centers for Medicare & Medicaid Services sent new Medicare cards to all beneficiaries in 2018. On the new cards, the Social Security number was replaced by the Medicare claim number to help better protect the identity of each beneficiary and make it harder for someone to commit fraud.
What Is My Medicare Beneficiary Identification Number
Your Medicare Beneficiary Identifier number is for billing and identification purposes.
On a Medicare card received before 2015, your Medicare Claim Number consisted of your Social Security number followed by a code of letters and sometimes numbers that have a specific meaning.
In more recent years, a randomly-generated combination of letters and numbers replaced this Medicare Claim number.
Removing Social Security numbers from Medicare cards further protects the identities of Medicare beneficiaries. The replacement number is called the Medicare Beneficiary Identifier, or MBI number.
Moreover, if you still have a Medicare card with your Social Security number on it, you can still use it. Nonetheless, getting a new Medicare card is certainly in your best interest.
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Other Ways To Obtain A Medicaid Provider Number
The Centers for Medicare & Medicaid Services has 10 regional offices in different cities and states 2. Atlanta, Chicago and New York are just a few to mention. If you want to enroll in the Medicare provider services program in person, go to the nearest regional office.
Any questions related to the enrollment process and other services can be communicated by phone 2. For example, if you have general questions about the program, you may call 800-633-4227, the Medicaid phone number. Another option is to access CMS.gov, select Contacts Database and search for a Medicaid office for a Medicaid customer service representative in your area.
Health care professionals can also fill out and mail their enrollment forms and all supporting documentation to a local Medicare administrative contractor servicing their state. Signatures must be handwritten. The application forms are available on the CMS.gov website under the Enrollment Applications section.
- The Centers for Medicare & Medicaid Services has 10 regional offices in different cities and states 2.
- Health care professionals can also fill out and mail their enrollment forms and all supporting documentation to a local Medicare administrative contractor servicing their state.
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Will My Medicare Number Change
Normally your Medicare identification number does not change, but in 2015 the Medicare Access and CHIP Re-authorization Act was passed by the United States Congress. … Your new MBI has 11 characters that consist of numbers and capital letters. To avoid confusion, an MBI will not contain the letters S, L, O, I, B, or Z.
New Medicare Id Numbers Mandatory January 1 2020
Medicare has removed Social Security numbers from Medicare cards. This step is to help prevent fraud, help eliminate medical identity theft, and to protect program funding and the private healthcare and financial information of our Medicare beneficiaries.
The new Medicare cards, issued by CMS, have a unique, randomly-assigned number called a Medicare Beneficiary Identifier that replaces the existing Social Security-based Health Insurance Claim Number . The new numbers are listed on the cards and in the various CMS systems in use now. The new cards have been mailed to people with Medicare benefits throughout the country. Medicare Handbooks contain additional information about the new cards. Be sure your staff is prepared to answer questions or direct patients to the Medicare website for more information. The new card is show below along with explanations about the changes.
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Does Everyone Have A Medicare Part B Id
Everyone who enrolls in Medicare receives a red, white, and blue Medicare card. This card lists your name and the dates that your Original Medicare hospital insurance and medical insurance began. It will also show your Medicare number, which serves as an identification number in the Medicare system.
Where Can I Find My Medicare Number
The red, white, and blue Medicare card has your Medicare number on it.
The Medicare Beneficiary Identifier is also visible on paperwork and documents from the Social Security
Administration and Medicare. Otherwise, you would have to visit your areas Social Security Administration or Medicare office. Alternatively, you can call Medicare and request a new Medicare card after correctly establishing your
identification.
Because your Medicare number is your protected health information, it is not readily available. As
a result, Medicare allows you to create an online account to view and print your Medicare card to obtain
the required information.
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Proposed Australia And Access Cards
Several unsuccessful proposals have been made to expand the scope of use of the Medicare card, such as the an Australia Card proposal.
In 2005, plans to expand the functions of the Medicare card were announced by then Howard Government Human Services Minister Joe Hockey. The new card, to be called the Access Card, was intended to replace both the Medicare and up to 17 other similar cards , and to commence operation in 2008. However, the scheme was criticised by some sectors of the public and relevant interest groups as a step in the same direction of an Australia Card. The Howard government was unable to implement the scheme before the government’s electoral defeat in 2007.
The incoming Labor Government announced on 7 December 2007 that the Access Card scheme would be abandoned. The same aims were later achieved with myGov from 2013.
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If you have a Medicare Advantage or Medicare Part D prescription drug plan, you will likely have a card for that plan that also contains a beneficiary identification number.
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How Is A Medicare Beneficiary Identifier Formatted
A Medicare MBI number contains 11 characters, which are randomly generated without underlying meaning. The MBI number is a string of numbers and upper-case letters, which will include an arbitrary combination of digits and any letters in the alphabet except B, I, L, O, S, and Z. These are excluded to prevent confusion with similar-looking letters. There are no hyphens or spaces in these sequences, so if you see an example of an MBI that has them, remember that this is only for illustration purposes. If you include these characters in your claim, it could be rejected.
On a Medicare card, an MBI will appear similar to this: 1EG4-TE5-MK73. The second, fifth, eighth, and ninth characters are always letters while the first, fourth, seventh, tenth, and eleventh characters are always numbers. You can visit cms.gov for more information on the format of an MBI.
Do You Need A Social Security Number To Get Medicare
Social Security Numbers Continue to be used for Medicare ID purposes. While the letter codes do not appear on your Social Security card, they are used on your Medicare card. Your Medicare claim number is the Social Security number of the primary wage earner on which benefits are based, plus your appropriate letter code.
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Npi Instructions For Sole Providers Group Members And Llcs
Q: I am a provider with a sole proprietorship. Do I receive two NPIs ?A: No. You would only receive a Type 1 NPI. A sole proprietorship is a form of business in which one person owns all assets of the business and is solely liable for all the debts of the business in an individual capacity. Therefore, sole proprietorships are not considered organization healthcare providers for purposes of the NPI Final Rule and thus cannot obtain organization NPIs. In terms of NPI assignment, a sole proprietor would be an Entity Type 1 and would be eligible for a single NPI. As an Individual, the sole proprietor cannot have a subpart and cannot designate subparts.
Q: I am a sole provider who is incorporated. Do I receive two NPIs ?A: If you are an individual who is a healthcare provider and is incorporated, you need to obtain an NPI for yourself and an NPI for your corporation .
Healthcare providers who are individuals are eligible for an Entity Type 1 NPI. If these individuals incorporate themselves and the corporations are healthcare providers, the corporations are organization providers that are eligible for an Entity Type 2 NPI. If either of these healthcare providers are covered providers under HIPAA, the NPI Final Rule requires them to obtain NPIs. Visit the CMS website for more information.
Q: I am a provider who is affiliated with two different groups. Do I receive two NPIs? A: An individual is assigned only one NPI regardless of the number of places where he/she may practice.
How Your Medicare Claim Number Is Used
Medicare beneficiaries generally do not have to file claims on their own. When you receive care, your health care provider will take your Medicare card and use the claim number on the front of your card to file a claim on your behalf. According to Medicare rules, health care providers have one year from the date of service to file a claim.
If for some reason you must file a Medicare claim yourself, you must complete the Patient Request for Medical Payment along with an itemized bill for your services or items and a letter detailing the reason for filing the claim yourself.
These documents must be submitted to the appropriate Medicare Administrative Contractor . These are private health care insurers that have jurisdiction for processing Medicare claims in their respective geographic areas.
You may for assistance filing a claim.
Once your claim is filed, you may track it online in your MyMedicare.gov account within 24 hours of filing. You will also receive a Medicare Summary Notice in the mail every three months detailing all your claims for that period.
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National Provider Identifier Numbers
The Centers for Medicare and Medicaid Services requires that all health care providers, including audiologists and speech-language pathologists, obtain a National Provider Identifier . All health care providers and organizations are eligible to receive NPIs.
Getting an NPI is free not having one can be costly.
For more news and updates, go to the NPI page on the CMS website.
What Is A Payer Id
A payer ID is a unique ID thats assigned to each insurance company. This ID is used to submit claims electronically through our system. The payer ID is typically a 5 character code, but it could be longer.
Note: Payers sometimes use different payer IDs depending on the clearinghouse theyre working with. Because of this, its possible the payer ID youve previously used wont match the ID listed in our system.
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Who Does The New Medicare Beneficiary Identifier Affect
As of January 1, 2020, the Medicare Access and CHIP Reauthorization Act of 2015 requires the Centers for Medicare & Medicaid Services to use MBIs on Medicare cards instead of SSNs. The change will impact every healthcare provider, physician, and supplier that submits claims to the Medicare Administrative Contractors for any services rendered to Medicare beneficiaries.
As a result of the MACRA, an MBI lookup tool will be added to all MAC web portals. No matter when services were provided, all providers must now use MBIs on all Medicare transactions. Only these identifiers will be accepted on Medicare claim submissions with few exceptions, although the IRS and the SSA will still use SSNs for tax and other similar purposes.
How To Replace Your Medicare Card
Call 1-800-MEDICARE and follow the automated prompts for reporting and replacing a lost or stolen card. You may also print a temporary copy of your card through your MyMedicare.gov account.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles hes written, helping Americans better understand their health insurance and Medicare coverage.
Christians work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christians passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelors degree in journalism.
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Old Medicare Card Vs New Medicare Card
As you can see from the front of the new card, there are significant differences. The changes are listed below:
CMS has developed a process that allows doctors and other healthcare providers to look up the new MBI using a secure tool at the point of service. The 21-month transition period that ends on 1/1/2020 has made this change easier. But take note: you will NOT be able to use the HICN for billing purposes after 12/31/19. You must use only the MBI.
Applying For Npis And Submitting Npis To Magellan
Q: How do I apply for my NPI? A: If you have not yet applied for an NPI, you should do so as soon as possible in one of three ways:
- For the most efficient application processing and the fastest receipt of an NPI, use the web-based NPI application process. Log on to the National Plan and Provider Enumeration System and apply online at .
- You can agree to have an electronic file interchange organization submit application data on your behalf if an EFIO requests your permission to do so.
- You may wish to obtain a copy of the paper NPI Application/Update Form by contacting the Enumerator:
P.O. Box 6059Fargo, ND 58108-6059
Q: If an electronic file interchange organization obtained my NPI for me, how do I obtain a copy of the NPI notification?A: You should contact the EFI organization that obtained the NPI for you.
Q: Does Magellan accept NPIs on paper claim forms ? A: Yes. Magellan accepts and strongly encourages you to submit NPIs on both the CMS-1500 and the UB-04 forms. Several of our customers require NPIs on paper claims as well.
Q: Where are the main NPI and rendering NPIs to be inserted on electronic transactions and on the paper claims forms?A:
Q: What is a Type 1 NPI and Type 2 NPI?A: Type 1 Healthcare providers who are individuals, including physicians, psychiatrists and all sole proprietors. An individual is eligible for only one NPI.
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What Do The Codes Following My Social Security Number Mean
Some people still keep and use the original copy of their red, white, and blue Medicare card containing their Social Security number.
After the Social Security number, there is a letter and sometimes a number. These codes all have different meanings.
The most common letters to find on your card following your Social Security number are A and B.
If you have an A on your card, it means that you are the primary beneficiary. That means you earned Medicare insurance based on your working history and tax credits.
If you have a B following your Social Security number, you are registered with Medicare as the spouse of a retired worker who earned Medicare.
There are several variations to the B code:
- B1 is for a husband of a primary beneficiary at age 62 or over.
- B2 is for a young wife with a child in her care,
- B3 is for an aged wife over the age of 62 who is a second claimant
- B5 is also a second claimant wife, but they are under the age of 62 and have a child in their care.
- B6 represents a divorced wife over the age of 62
- is for a young husband with a child in his care.
Additionally, Codes C1-C9 represent children who may be minors, students, or disabled.
The letter D follows for aged widows over the age of 60 or a surviving divorced wife over the age of 60.
The letter E code is for a widowed mother, while E1 is a surviving divorced mother.
E4 is a widowed father, and E5 is a surviving divorced father.
The letter F codes are for parents.
