Home Health & Hospice Week

MBI-HICN mismatch causes returned claims.

Medicare has completed replacing benefi­ciaries old Health Insurance Claim Numbers, which were based on Social Security numbers, with new Medicare Beneficiary Identifier numbers. But the billing transition is not as settled.

Reminder: Although the Centers for Medicare & Medicaid Services has finished issuing MBIs to all existing beneficiaries, Medicare claims systems will take HICN numbers or MBI numbers until Dec. 31.

The transition period seems to be giving rise to a problem described by HHH Medicare Administrative Contractor CGS. “In some situations where providers are submitting claims under the Medicare Beneficiary Identifier (MBI), the claim processes under the beneficiary’s Health Insurance Claim Number (HICN). This seems to occur when the Common Working File (CWF) shows that a new HICN is assigned to the beneficiary,” CGS says on its claims processing problems webpage.

“New and subsequent claims are processing under the new HICN; when the prior claim information is under the old HICN and is not cross referencing to the new HICN,” CGS continues. “This is causing claims to go to the return to provider (RTP) file with reason code 38107 (matching home health RAP cannot be found) and 37402 (hospice sequential billing).”

The issue has been reported to the system maintainer, the MAC says.