Medicare Beneficiary Identifier (MBI)

Requests to change a Medicare Beneficiary Identifier (MBI) can occur if a Medicare beneficiary, their authorized representative, or CMS suspects a number is compromised. If CMS reissues MBIs, it is possible your patients will seek care before receiving a new card with their new MBI.

Your patient’s MBI may have changed if you receive an eligibility transaction error code (AAA 72) of “invalid member ID,” or the eServices Eligibility Inquiry message, “The beneficiary you requested cannot be found. Please verify your information.”

When an MBI changes, the beneficiary is advised to share the new MBI with their providers. If you cannot obtain the new MBI from the patient, you can get it from the eServices MBI Lookup Tool. Sign up for eServices now to use the tool. Instructions for using the MBI Lookup Tool can be found in the eServices User Manual (PDF). The Provider Contact Center cannot disclose the new MBI.

You can find the termination date of the old MBI by doing a historic eligibility search in eServices. The termination date will be returned in the MBI End Date field of the Eligibility tab.

Last Reviewed: 12/19/2024

It is important to verify patient eligibility prior to admission and prior to billing. Submitting the appropriate MBI based on the effective date of issuance and the dates of service being billed will help avoid claim edits and ensure proper billing and efficient processing.

Palmetto GBA’s eServices offers two tools to verify a beneficiary’s MBI is current.

1. The “MBI End Date” field in the Eligibility tab

a. If there is a date present in the field, the MBI is not valid for submissions after that date

i. To retrieve all eligibility information available, you must enter a valid date range on the inquiry page. Date ranges may not exceed 24 months at a time. The entered date range may include a future date (up to (4) months in the future) to insure the MBI is not pending an upcoming change.

ii. The example below shows a termination date of 06/05/2022. To get this response, the entered date range must overlap the termination date. If the date range does not overlap, no beneficiary eligibility information will return.

2. MBI Lookup

a. This lookup only provides the current MBI

b. When you click on the MBI Lookup tab, you will be presented with the MBI Lookup screen. The user should enter a beneficiary’s information into the fields and use the Submit Inquiry button. To protect the privacy of beneficiary data, all fields entered, including optional fields, must match the beneficiary’s data; otherwise, MBI data will not be returned.

Late NOAs and NOEs Due to MBI Changes
Effective for NOAs on January 1, 2024, and May 15, 2023, for NOEs, A/B MAC MACs will not grant exceptions based on MBI changes that were accessible to the HHA or hospice more than two weeks prior to the admission date. Since current beneficiary identifier information is available to HHAs and hospices in eServices’ MBI Lookup tab or other MAC’s provider portal, only changes that occur shortly before the admission are beyond the HHA or hospice’s control.

Resources

•  Getting MBIs
• eServices User Manual (PDF)
• Medicare Beneficiary Identifiers (MBIs)
• Home Health and Hospice Billing When a New Medicare Beneficiary Identifier Is Assigned

Last Reviewed: 12/19/2024