What is the purpose of NBI medic?
The purpose of the NBI MEDIC is to detect and prevent fraud, waste, and abuse in the Part C (Medicare Advantage) and Part D (Prescription Drug Coverage) programs on a national level. Health Integrity is the Medicare Part C and Part D program integrity contractor for the Centers for Medicare & Medicaid Services (CMS).
What is the new Medicare beneficiary identifier (MBI)?
Effective January 1, 2020, all claims and eligibility inquiries submitted to Medicare must use the new Medicare Beneficiary Identifier (MBI). If your patients are unable to provide you with their updated card, the MBI Lookup tool is available in Novitasphere, our free, secure internet portal!
What does Medicare Code B mean?
That means you earned Medicare insurance based on your working history and tax credits. If you have a B following your Social Security number, you are registered with Medicare as the spouse of a retired worker who earned Medicare. There are several variations to the B code:
When to use the MBI and hicn for beneficiary information?
Beneficiary information/eligibility inquiries: written inquiries or self-service options. Refer to When to Use the MBI for more information. CGS encourages suppliers to use the MBI for all workloads. However, there are a few exceptions when you can use either the HICN after January 1, 2020, if you are unable to obtain the MBI:
Where do I find my Medicare beneficiary identifier number?
You can identify them by the RRB logo on their card, and we return a “Railroad Retirement Medicare Beneficiary” message on the Fee-For-Service (FFS) MBI eligibility transaction response. The beneficiary or their authorized representative can request an MBI change. CMS can also change an MBI.
What does a Medicare MBI look like?
MBI will contain Numbers and letters (Uppercase), that will use 0 to 9 numbers and all letters from A to Z, they have excluded S,L,O,I,B and Z so that will help all characters to easier to read. The MBI's 2nd, 5th, 8th, and 9th characters will always be a letter. Characters 1, 4, 7, 10, and 11 will always be a number.
What is the difference between Hicn and MBI?
The MBI has 11 characters, like the HICN, which can have up to 11. Each MBI is randomly generated which makes MBIs different than HICNs, which are based on the SSNs of Medicare recipients. MBI characters are “non-intelligent” so they don't have any hidden or special meaning.
What is the Medicare identification number?
Your card has a Medicare Number that's unique to you — it's not your Social Security Number. This helps protect your identity. The card shows: You have Medicare Part A (listed as HOSPITAL), Part B (listed as MEDICAL), or both.
When did MBI go into effect?
Jan. 1, 2020Effective Jan. 1, 2020, all providers are required to use MBI to identify beneficiaries in provider transactions.
What does BNC number stand for?
Beneficiary Notice CodeA BNC number is a Beneficiary Notice Code used by the Social Security Administration to identify documents and notices. Learn more about BNC codes and other numbers related to Social Security and Medicare.
Is Hicn same as Medicare number?
Slide 1. The Health Insurance Claim Number (HICN) is a Medicare beneficiary's identification number, used for paying claims and for determining eligibility for services across multiple entities (e.g. Social Security Administration (SSA), Railroad Retirement Board (RRB), States, Medicare providers and health plans, etc. ...
What do the letters mean on your Medicare card?
All “F” codes are followed by a number to signify the relationship. Code H — indicates Medicare eligibility due to disability. HA means you are a disabled claimant. HB means you are the wife of a disabled claimant. HC means you are the child of a disabled claimant.
How many digits is a Hicn?
Health Insurance Claims Numbers (HICNs) The HICN issued by the RRB, may contain either 6 or 9 digit numbers with up to a 3-position letter prefix e.g., A123456 or MA123-45-6789. If a beneficiary's entitlement changes, it is possible for the 9-digit number, the prefix, the suffix or all three to change.
What is the 11 digit Medicare number?
A complete Medicare number requires 11 digits in total. This includes your 10-digit Medicare number on your card followed by the unique reference number that appears next to your name. Please take extra care when entering you Medicare Number, it is extremely important to ensure it is 100% correct.
Is Ptan the same as Medicare ID?
Provider Transaction Access Number (PTAN) A PTAN is a Medicare-only number issued to providers by MACs upon enrollment to Medicare. When a MAC approves enrollment and issues an approval letter, the letter will contain the PTAN assigned to the provider.
Is a Medicare card the same as a Social Security card?
Instead of your Social Security Number (SSN), your new Medicare card will include a new number unique to you. This will help to protect you against identity theft and protect Medicare from fraud. Medicare will automatically mail your new card to the address you have on file with Social Security.
What is a B1 on Medicare?
There are several variations to the B code: B1 is for a husband of a primary beneficiary at age 62 or over. B2 is for a young wife with a child in her care,
What information is on my Medicare card?
There is additional important information located on your Medicare card for you and your doctor. This includes your name and sex. Additionally, it states whether you have Medicare Part A (inpatient hospital) and Medicare Part B (outpatient medical), and lists the dates that Part A and B first started.
What happens if you lose your Medicare card?
If you lose your Medicare card with your number on it, you can request that the Social Security Administration replace your card at no charge. The Medicare Beneficiary Identifier is for claims, billing and identification purposes.
How long does it take for Medicare to arrive in the mail?
After your replacement request, the card typically arrives in the mail in about 30 days, at no cost to the beneficiary. Social Security will mail your Medicare card to the address they have on file for you, so it is important to keep your information with them up to date.
What is a B3 wife?
B3 is for an aged wife over the age of 62 who is a second claimant. B5 is also a second claimant wife, but they are under the age of 62 and have a child in their care. B6 represents a divorced wife over the age of 62. BY is for a young husband with a child in his care.
Can I use my Social Security number on my Medicare card?
Removing Social Security numbers from Medicare cards further protects the identities of Medicare beneficiaries. The replacement number is called the Medicare Beneficiary Identifier, or MBI number. Moreover, if you still have a Medicare card with your Social Security number on it, you can still use it. Nonetheless, getting a new Medicare card is ...
What is Medicare NBI?
National Benefit Integrity Medicare Drug Integrity Contractor (NBI MEDIC) The purpose of the NBI MEDIC is to detect and prevent fraud, waste, and abuse in the Part C (Medicare Advantage) and Part D (Prescription Drug Coverage) programs on a national level. Health Integrity is the Medicare Part C and Part D program integrity contractor for ...
What is the CPI in Medicare?
The Center for Program Integrity (CPI) CPI serves as the CMS focal point for all national and state-wide program integrity, fraud and abuse issues in the Medicare and Medicaid programs, and the Children's Health Insurance Program (CHIP). Specifically, the Division of Plan Oversight and Accountability ...
What is a NIP report?
The NIP indicates the audit issue being reviewed, the applicable laws, the amount of the overpayment, how it was calculated and the plan sponsor’s appeal rights. The Improper Payment Exception Report, an encrypted file sent with the NIP, will include the PDE records associated with the identified improper payment.
What is a RFI in health insurance?
A review determined to require response to a Request for Information (RFI) from the plan sponsor to adequately validate compliance with CMS policy and applicable laws. RFIs may include requests for prescriptions, prior authorizations or other documentation as required to address the specific issue under audit.
Can you get reimbursed for Medicare if you are excluded?
Items and services furnished, ordered, or prescribed by an excluded individual or entity will not be reimbursed under Medicare, Medicaid, and all other Federal health care programs until the individual or entity is reinstated by the Office of Inspector General (OIG).
What is NBI MedIC?
NBI-MEDIC direct contractor support/Health Integrity has a policy for handling sensitive informationand storage and destruction. For hard copy sensitive data, locked recycle bins are placed indesignated locations. These bins are used to discard documents or papers with PersonallyIdentifiable Information (PII) and/or confidential data or information. The company's contractedvendor comes to empty recycle bins and shreds the contents on-site. Backup tapes from the systemare stored in a secured offsite facility . All tapes are considered sensitive (may contain ProtectedHealth Information (PHI/PII) and are tracked from initial use through to disposal using bar-codelabels which are scanned by both the backup operators, as they move from Data Center to vault,and by the destruction vendor. The destruction services is in accordance with NIST SP 800-88Guides for Media Sanitization. National Archive Records Association (NARA) record retentionschedule citation number is (Disposition Authority: N1-440-04-3, Item 1a) Hardcopy Records - Thehardcopy must be retained onsite until the microform has been verified. Cut off at the close of thecalendar year in which paid; transfer hardcopy to a Federally-approved records storage facility only ifthere is a corresponding master microfilm record that can be retained for the period indicated in b.below; otherwise, the hardcopy shall be retained until the 6 years and 3 months period is reached.Earlier cutoff and transfer is authorized. However, the hardcopy must be retained for a total retentionof 3 years after the close of the calendar year in which paid.
How often is NBI Medic training?
The training includes peer training, slidepresentations, manuals and guides, and work instructions. Training is conducted at least once a yearand whenever the need for supplemental or new training arises.
What is NBI GSS?
NBI-MEDIC GSS utilizes several network monitoring tools to ensure data protection , integrity and system availability including system event monitoring and intrusion detection. Accuracy and relevance of the data is reviewed by the data analysis team.
Where is Medicare information obtained?
Information is obtained directly from Medicare direct contractors, claims processing systems andfrom a tap file on the National Claims History(NCH) feeds. Medicare beneficiaries sign a privacy actnotice when they become eligible for Medicare. This act informs them that information they provideto justify payments, will be used to determine the appropriateness of the payment. Notices andconsents are provided to individuals whose data is in the Medicare sources that feed the MEDICSystem through Federal Register System of Record notices.
What is Medicare GSS?
National Benefit Integrity (NBI)-Medicare Prescription Drug Integrity Contractor (MEDIC), GeneralSupport System(GSS) is used to perform fraud and abuse investigation, support benefit integrityefforts, provide medical review support, national and regional data analysis, and law enforcementsupport. NBI-MEDIC (GSS) uses a variety of systems to perform its fraud and abuse investigationfunctions using the received claims, beneficiary, and provider data for Medicare. All of these systemsrun on data centers. The primary systems used on a day-to-day basis include the Health InformationTracking System (HITS) and the Common Working File (CWF) System.
When will Medicare start using MBI?
Medicare Beneficiary Identifier (MBI) Lookup through Novitasphere. Effective January 1, 2020, all claims and eligibility inquiries submitted to Medicare must use the new Medicare Beneficiary Identifier (MBI).
What is MBI lookup?
The MBI Lookup will require users to enter the patient’s First and Last Name, Date of Birth, and Social Security Number to search. As an added measure to protect patient privacy, CMS requires that users will also need to complete the “I am not a robot” verification once for every five searches. The MBI Lookup tool is available only within ...
When is MBI required for Medicare?
Effective January 1, 2020 : The MBI is required for all transactions submitted to Medicare including (not all inclusive) Claim Submission: electronic and paper claim submissions for all dates of service. Claims received with HICNs will be rejected, even for dates of service prior to January 1, 2020.
When to use MBI for claim status?
Claim status query – You should use the MBI if available, but are allowed to use the HICN to check the status of a claim (276 transactions, or within the IVR or portal) if the earliest FROM date of service on the claim is before January 1, 2020.
Is a Medicare card a confidential information?
The MBI is confidential and should be protected as Personally Identifiable Information. Effective January 1, 2020: The MBI is required for all transactions submitted to Medicare including (not all inclusive) ...
Can a beneficiary change MBI?
The MBI may be changed due to a beneficiary or authorized representative request, or CMS may initiate the change. Refer to " What to Do If the MBI Changes .". Using the old or new MBIs in relation to claim submissions: Span-date claims with a "From Date" before the MBI change date – use the old or new MBI.
What does NPI mean in healthcare?
This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.
What is a provider NPI?
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.
What is NPI in HIPAA?
The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. As outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it ...
Medicare Beneficiary Identifier (MBI) Converter
Check the MBI that you entered to ensure it is in the correct format. The MBI format for each position is:
Beneficiary Name to Number Converter
Type the beneficiary's first initial of their first name and the first six letters of their last name in the "Enter Name" field. When the last name is less than 6 letters, the converted number must be followed by ‘#’ when you enter it on your telephone keypad.
