Medicare Compliance & Reimbursement

Question: A few of our Medicare patients’ claims have been rejected, despite using their Medicare Beneficiary Identifiers (MBIs). Am I doing something wrong?

Codify Subscriber

Answer: If you’re getting rejections due to incorrect MBIs, do some research into the error code.

“If you get an eligibility transaction error code (AAA 72) of ‘invalid member ID,’ or ‘The the beneficiary you requested cannot be found. Please verify your information,’ your patient’s MBI may have changed” since it was originally issued, the Centers for Medicare & Medicaid Services (CMS) explains in a new article. “Remember, requests to change MBIs can occur if a Medicare beneficiary, their authorized representative, or CMS suspects a number is compromised.”

Patients may give you the old card or seek care before receiving a new one.

When you get such an error code, “do a historic eligibility search to get the termination date of the old MBI,” CMS advises. Then, “get the new MBI from your Medicare Administrative Contractor’s secure lookup tool.”

Remember: You’ll need the beneficiary’s first and last name, birthdate, and Social Security number (SSN) to use the MBI look-up tool, notes MLN Matters SE18006, which was revised on March 19 to address this problem.

See the revision at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE18006.pdf.