Updated Eligibility Inquiry Responses to Accommodate New Medicare Beneficiary Identifier
The Centers for Medicare & Medicaid Services (CMS) has issued guidance regarding upcoming changes to Eligibility Inquiry (E1) responses received by pharmacies. CMS is implementing these changes in support of the New Medicare Card Project.
Background
The Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) of 2015 requires that Social Security Numbers (SSN) be removed from all Medicare cards by April 2019. The SSN-based Health Insurance Claim Number (HICN) will be replaced by the Medicare Beneficiary Identifier (MBI). More information about the New Medicare Card Project can be found at https://www.cms.gov/Medicare/New-Medicare-Card/index.html. Beginning April 1, 2018, the E1 response will include the beneficiary MBI and the MBI effective date when a beneficiary match is found and the beneficiary has an assigned MBI. If a beneficiaries MBI was compromised, the E1 response will include the MBI that is effective on the date of the E1 transaction.
*Please see attached for more information.