Practice Management Alert

Question: When submitting a claim for a transgender patient who’s a Medicare beneficiary, which sex do I put on the claim?

California Subscriber

Answer: Medicare Beneficiary Identifier (MBI) cards, which are required for all billing, eligibility, and claims status questions and transactions for beneficiaries, beginning Jan. 1, 2020, do not list sex. The previous Medicare cards used the health insurance claim number (HICN), which was based on a person’s Social Security number, and listed the person’s sex. Even though sex is no longer listed on the person’s MBI card, the information attached to the MBI is based on records kept by the Social Security Administration (SSA). So whatever sex the person has listed for their Social Security records is what you should put on anything connected to Medicare.

Accuracy is important here: “… if a person is enrolled in Medicare, or the Medicaid and Supplemental Security Income (SSI) programs, their insurance record will be based on Social Security data. In that case, they may experience automatic refusals for coverage of services that appear inconsistent with a gender marker in Social Security records,” the National Center for Transgender Equality says.