How are Home Health RCD Unique Tracking Numbers Impacted When a New MBI Is Assigned?

Published 06/20/2024

When a patient’s MBI changes, you may need to take action in order for your claims to process.

Here’s a scenario you may face:

  • You have submitted your patient eligibility check prior to the PCR submission and received a response
  • The MBI of the patient returned as active and you move on to your PCR submission
  • The submission was received, reviewed, and an affirmed UTN was provided 
  • The service is performed, and you later attempt to submit the claim with the affirmed UTN and discover the MBI has changed since your prior eligibility check

What do I do if I have an affirmed UTN under the terminated MBI and need to bill with the new MBI?

If the MBI on the UTN is not the same as the MBI on the claim, the system will be unable to locate the UTN when you bill the claim. Your claim will typically edit with reason code C5462 in the above scenario.

To get this claim to process, you will need to:

  1. Contact the PCC and request that the UTN be updated with the new MBI. You will need to provide:

a. The old MBI
b. The new MBI
c. The UTN
d. The dates of service

  1. Write down the reference number that you receive for this call so you can follow up on the request later.
  2. The call will then be escalated, and a technician will change the MBI that is associated with the UTN.
  3. Once you confirm that the MBI has been updated, you will bill the claim with the UTN as you normally would.

Related Articles

Was this article helpful?