Patient's Medicare Beneficiary Identifier (MBI) has Changed


A patient’s Medicare Beneficiary Identifier (MBI) number is required on all home health and hospice billing submitted to Medicare.  It is important to verify eligibility prior to or during admission to make sure the correct MBI is documented.  Medicare will not grant exceptions based on MBI changes, since their is information available to the HHA such as the MBI Lookup Tool as well as other MAC's provider portals.  An invalid MBI on NOAs (Notice of Admissions) or NOEs (Notice of Elections) may cause them to be late, causing your agency to receive payment penalties.  If you have problems getting information from the patient, PalmettoGBA provides an MBI Lookup Tool.  For more information, click here

When do I start using the new MBI?

You will need to use the new MBI for dates of service on or after the effective date of the MBI change.

What do I need to do if MBI has changed during an admission?

Making Changes in Barnestorm:

If the patient's MBI changes during an active admission, you will need to put an end date to the old MBI number in the patient's referral, and add a new entry with the new MBI. Click here on how to discharge a payer.

My End of Episode (EOE) has denied due to Reason Code U5065: The Medicare MBI Effective or End Date is not within the claim dates of service.

This means you are using an invalid MBI on your claim. 

1.  First, discharge the payer with the old MBI, and put in a line entry with the new MBI. Follow steps above to discharge payer.

2.  Next, create a new claim with the new MBI.  In some cases, you may also have issues with the corresponding OASIS.  If so, you will need to follow process to Inactivate and Resubmit the OASIS, only after the new MBI has been put in.  Click here for steps on how to correct OASIS.  **Verify the OASIS has been accepted, before resubmitting the EOE.

Here are a few scenarios, identified on PalmettoGBA, that Home Health and Hospice agencies have encountered due to MBI Change:

  1. The NOA processed under the old MBI. The NOA does not need to be canceled and resubmitted under the new MBI. The HHA needs to enter the new MBI on all future billing on or after the effective date of the new MBI. The HHA must also update the OASIS, if needed, to ensure the MBI on the OASIS and claim match. 
  2. The admission period has started and the NOA and period of care claim(s) processed under the old MBI. Everything processed in the Medicare claims system remains — there is no need to cancel the claim(s) or NOA in order to resubmit under the new MBI. All billing on or after the effective date of the new MBI must be submitted with the new MBI. HHAs must ensure the MBI on the OASIS matches the new MBI billed on the claims.
  3. Claim adjustments must use the current MBI, even if the original claim was submitted with an old MBI

Hospice scenarios when a new MBI is issued.

  1. The NOE processed under the old MBI. The NOE does not need to be canceled and resubmitted under the new MBI. The hospice needs to enter the new MBI on all future billing on or after the effective date of the new MBI. 
  2. The NOE and monthly claim(s) processed under the old MBI. Everything processed in the Medicare claims system remains — there is no need to cancel the claim(s) or NOE to resubmit them under the new MBI. All billing on or after the effective date of the new MBI must be submitted with the new MBI. 
  3. Claim adjustments must use the current MBI, even if the original claim was submitted with an old MBI

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