Important 2020 Medicare Beneficiary changes! HME & Pharmacy claims!

Here are some pro-tips & reminders for dealing with Medicare patients in 2020!

HME Providers/Claims

  • REGARDLESS OF DOS, BILL WITH THE LATEST MBI. Just like before, beneficiaries are losing their MBI cards and/or are remaining ever vigilant about their identities. Some patients have already received their 2nd and 3rd MBI since the movement began. You will be alerted that there is a problem on your eligibility check, or when Medicare denies your claim with an: A7, 164, 16, or N382 Here's the revised MLN Matters article about the process.


  • NOT ALL LETTERS ARE CREATED EQUAL. MBI numbers are a mix of numbers and letters, and many of you still pick up the phone from time to time to check eligibility. Even if you were a great T9 text messenger back in the days of flip phones, check out the guides from your IVR about how to type an MBI into an IVR phone system. We recently found out not all letters correspond to the number you'd think they do!


  • 3 CONSTANTS IN THIS WORLD: DEATH, TAXES, AND NEW MBI'S.  All living beneficiaries AND those who have passed away within the timely filing limit will be issued a new MBI number which should be used for claims.  If you are billing older claims for a patient who has passed away, you will still need to utilize the MBI number.


Pharmacy Providers/NCPDP Claims

  • As a reminder the Centers for Medicare and Medicaid Services (CMS) ended the transition period to allow the use of HICN as of December 31, 2019. Effective January 1, 2020 CMS requires the Medicare Beneficiary ID (MBI) on all transactions.

    As part of the MBI initiative, pharmacies may no longer submit the Health Insurance Claim Number (HICN) and the Railroad Retirement Board (RRB) Number in the Cardholder ID field (302-C2) on the eligibility (E1) request for Parts A/B and D.

    Pharmacies can still submit an E1 using the MBI, SSN and SSN4 in the Cardholder ID field.

    Additionally, the CMS Transaction Facilitator (RelayHealth) will no longer return the MBI or the MBI effective date on the E1 response.

    The CMS memo detailing some of the changes is attached and the updated payer sheets can be found here: