New Medicare Card: Claim Reject Codes After January 1, 2020

Get paid. Use Medicare Beneficiary Identifiers (MBIs) now.

If you do not use Medicare Beneficiary Identifiers on claims (with a few exceptions) after January 1, you will get:

Electronic claims reject codes: Claims Status Category Code of A7 (acknowledgment rejected for invalid information), a Claims Status Code of 164 (entity’s contract/member number), and an Entity Code of IL (subscriber)

Paper claims notices: Claim Adjustment Reason Code (CARC) 16 “Claim/service lacks information or has submission/billing error(s)” and Remittance Advice Remark Code (RARC) N382 “Missing/incomplete/invalid patient identifier”

We encourage people with Medicare to carry their cards with them since we removed the Social Security Number-based numbers; if your patients do not bring their Medicare cards with them:

Give them the Get Your New Medicare Card flyer in English (PDF) or Spanish (PDF).

Use your Medicare Administrative Contractor’s look-up tool. Sign up for the Portal to use the tool.

Check the remittance advice. Until the end of December, we return the MBI on the remittance advice for every claim with a valid and active Health Insurance Claim Number.

See the MLN Matters Article to learn how to get and use MBIs.

Background: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) required CMS to remove SSNs from all Medicare cards by April 2019. CMS replaced the SSN-based HICN with a new, randomly generated MBI. The new MBI is noticeably different than the HICN. Just like with the HICN, the MBI hyphens on the card are for illustration purposes: don’t include the hyphens or spaces on transactions. The MBI uses numbers 0-9 and all uppercase letters except for S, L, O, I, B, and Z. We exclude these letters to avoid confusion when differentiating some letters and numbers (for example, between “0” and “O”).

Note from your Revenue Cycle Management partner at ebix, Inc. – We are always at the forefront of industry insights and believe this article from mlnconnections will be of interest to you.