CMS Has Got Your Number – What Medicare ID Card Changes Mean for Health Care Payers

Medicare cards are getting a reboot and this means big changes for the healthcare industry. In April 2018, CMS will issue new Medicare ID cards to 150 million beneficiaries, living and dead. The new cards will replace the current health insurance claim number (HICN), which is based on the beneficiary’s social security number, with a randomly generated, 11-digit, alphanumeric Medicare Beneficiary Identification (MBI) number. The change is touted as a means of combatting identity theft and Medicare fraud, but the prospective overhaul has some health care professionals worried that the change will lead to further stratification of the flow of healthcare data.

To ease the healthcare industry’s growing pains, CMS has launched a proactive outreach program that includes educational materials, the weekly MLN Connects newsletter, and at least one special Open Door Forum to discuss the upcoming changes. CMS will also provide monthly crosswalk data files to Medicare and Part D plan sponsors so they can update their beneficiary information and cross-reference the old HICN numbers with the new MBI numbers. Congress has gotten in on the act as well, allocating $242 million spread over four fiscal years for the switchover, which was mandated as part of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. To facilitate the changeover, CMS will implement a 21-month transition period, beginning in April 2018 when it issues the first new cards and concluding in December 2019. During this period, CMS will continue to process claims containing the old HICN numbers in addition to claims that employ the MBI number.

While the MBI closely resembles the HICN in the number of characters, the shift is placing major demands on public and private entities to update their systems. For example, while CMS can simply repurpose the HICN field to accommodate the new MBI, it still needs to update 75 complex legacy IT systems used by the agency and its contractors to process Medicare claims. Hundreds of thousands of private systems will also need to be updated, bringing the cost of complying with the change to tens of millions of dollars.

While Medicare Advantage and Part D plan sponsors already use unique member IDs to communicate with providers, they will still need to adapt their systems and processes to accommodate changes to the ID cards. Marc Ryan, Chief Strategy and Compliance Officer for MedHOK, recommends taking these proactive steps to ease the transition:

1. Conduct a thorough inventory of all systems, including claims, sales, enrollment, and member services, to identify which ones are likely to be impacted by the changes.
2. Retrofit existing systems to accommodate dual use of HICN and MBI numbers during the transition period. You may need to add fields to system user interfaces (UI), databases, file loaders, searches, and reporting functions to give systems sufficient flexibility to function effectively during the transition.
3. Coordinate with downstream entities to ensure they have the technology and processes to accommodate ID card changes.
4. Verify plan beneficiary information with participating healthcare providers. For example, plan sponsors should make sure that each member beneficiary has an HICN and MBI number in place to prevent the creation of duplicate records.
5. Take advantage of the resources CMS is offering to prepare Medicare plan sponsors and providers for the change-over.

Preparing for the new ID cards may seem daunting, but it also represents a golden opportunity to optimize people, processes, and technology in the healthcare space. Whether you are a payer, provider, or healthcare administrator, you can take forward-thinking actions to keep pace with current changes and future-proof your business:

1. Adopt a bimodal approach to IT that employs traditional, predictable methods of development and deployment along with agile, innovative processes.
2. Invest in scalable solutions that embrace the cloud and open APIs.
3. Select vendor agnostic solutions that integrate with other applications in the digital ecosystem.
4. Eliminate silos by employing portal frameworks, centralized data and content repositories, and automated workflows.
5. Work with technology partners who understand the unique security requirements of the healthcare industry and have the resources to adequately safeguard protected information.
6. Employ solutions with streamlined UIs that engage and empower non-technical users.

By investing in scalable technology that optimizes processes and promotes collaboration, you can lay the foundation for a thriving business, no matter what changes come your way.

Looking for a partner to streamline your ID cards? Learn how Elixir’s work with one healthcare payer led to 75% faster ID cards in this case study.

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