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Provider Notice Issued 06/16/2021
Date: June 16, 2021
To: All Medical Assistance Program Providers
Re: Medicare Beneficiary Identifier (MBI) FieldCompletion for 837P Crossover Claims
This notice informs providers of a new claim completion requirementrelated to the Medicare Beneficiary Identifier (MBI) on Medicare crossover 837Pclaims. This requirement applies to fee-for-service claims for patientsenrolled under both Original Medicare and Medicare Advantage Plans. The new billingrequirement only impacts 837P claims submitted through a clearinghouse, notthose submitted through the MEDI system.
An HFS change in mapping of the MBI was necessary to allow tertiaryclaims to adjudicate correctly. Due to the mapping change, 837P crossover claimsthat are submitted through a clearinghouse must identify claim filing indicatorcode “MB” (for Medicare B) in Loop 2320, Segment SBR09. The actual MBIcontinues to be entered in Loop 2330A, Segment NM109.
Providers must inform their vendors of this mapping change. Claims thatdo not contain the claim filing indicator code “MB” will be rejected with errorcode K22 – MBI Does Not Match # on File.
Special Note for Providers of Encounter Clinic Services Who BillMedicare Primary on the Institutional Claim Format:
Providers who are required to bill Medicare as the primary payer on theinstitutional claim format must change theclaim filing indicator “MA” to “MB” in Loop 2320, Segment SBR09 of the 837Pbefore billing Medicaid as the secondary payer.
Questions regarding this notice may be directed to a billing consultantin the Bureau of Professional and Ancillary Services at 877-782-5565.
Kelly Cunningham, Administrator
Division of Medical Programs