Experian Health – Voice Your Concern to CMS About New MBIs – 04.04.2018

Last updated on April 7th, 2018 at 12:41 pm CT

Regarding the New Medicare Beneficiary Identification Project, Experian Health is providing you the opportunity to voice your concerns and send the attached recommended MBI Enhancement Request to CMS.

As we are all aware, the Medicare Beneficiary ID will be changing beginning in April 2018. While all of us advocate for Electronic Data Interchange standardization and compliance within the healthcare industry, there are some issues of which those who use Medicare’s eligibility system (HETS 270/271) should be aware. The current decision from CMS is that the MBI will be returned only on the eligibility response (271) if the MBI is used in the inquiry (270). CMS will require a provider to use a look up tool available through the individual MAC’s website when a provider cannot obtain the new MBI from the member. Additionally, CMS will be returning the MBI in the E1 NCPDP transaction (the pharmacy equivalent to the 270/271 transaction) if the HICN is submitted. Due to the complications this change will make to a provider’s workflow when registering a Medicare Beneficiary, we as an part of a larger EDI community have drafted a recommended enhancement request to CMS.

Please read the two links below that include a cover letter and instructions for the steps to follow to complete the attached template for the enhancement request to send to CMS. Experian Health has also sent this request to CMS.


(Previous Post - Reference)
Last and Previous Posts: March 29, 2018 - Deadline Approaching – New Medicare Beneficiary Identifier (MBI) – Update 
Last and Previous Posts: March 22, 2018 - Reminder – New Medicare Beneficiary Identifier (MBI), April 2018 – Update 
Last and Previous Posts: March 9, 2018 - New Medicare Beneficiary Identifier (MBI), April 2018 – Update

[March 29, 2018]
April 2018 – New Medicare Beneficiary Identifier (MBI) – Update, 03.29.2018  
The April, 2018 has arrived.  Please click this headline and review the information posted on our product dashboard under the New Medicare Beneficiary Identifier (MBI) April 2018  Experian Health is ready to accept both the HICN and MBI in the X12 270/271 Transactions (Eligibility Inquiry/Eligibility Response).  A new “My Response” coverage banner will also be added to within OneSource and eCareNEXT,   Within the returned 271 Eligibility Response, we will return the message segment:

“CMS mailed a Medicare Card with a new Medicare Beneficiary Identifier (MBI) to the Member”

For Premium EDI clients, we have created an Epic EDI alert that will return the same message. (Similar to when a patient has limited coverage, or a Medicare Advantage/Medicaid MCO.)
Please Note:  CMS will only return that message for beneficiaries that have traditional Medicare. If they’re enrolled in a Medicare Advantage plan, Medicare will not return this information.