Provider Notice Issued 12/13/2019

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Provider Bulletin

Handbook Supplement Update

Date:    December 13, 2019

To:       All Medical Assistance Program Providers

Re:      Health Insurance Claim Number Transition to Medicare Beneficiary Identifier January 1, 2020

           Handbook Supplement Update

This notice informs providers that the Department will follow Medicare Program policy and only accept the Medicare Beneficiary Identifier (MBI) on claims formerly requiring the Health Insurance Claim Number (HICN) beginning January 1, 2020. Additionally, as institutional claims did not require the HICN, new editing will require institutional claims to identify the MBI. These policies apply to claims submitted for participants covered under traditional fee-for-service as well as those covered under a managed care plan.

The Centers for Medicare and Medicaid Services (CMS) has replaced the Social Security Number-based HICN with the MBI. Starting January 1, 2020, providers who submit claims to the Department via paper invoice or electronically after disposition by Medicare must use the MBI. Until January 1, 2020, providers may use either the HICN or MBI.

Claims for institutional providers will now be edited to ensure that the provider has identified an MBI in Form Locator 60 (and its electronic format equivalents) and that the MBI is valid. Fee-for-service institutional and practitioner claims that do not identify a valid MBI after January 1, 2020 will receive denials with the following Department proprietary error code:

K22 - Missing or Invalid MBI Number

The Handbook Supplement contains updated paper billing instructions for the HFS 3797 - Medicare Crossover Invoice and UB-04 claim formats.   

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services or the Bureau of Hospital and Provider Services at 877-782-5565 for fee-for-service claims, or to the applicable managed care plan.

Doug Elwell

Medicaid Director