<img height="1" width="1" style="display:none;" alt="" src="https://dc.ads.linkedin.com/collect/?pid=293162&amp;fmt=gif">
Request A Demo
Request a demo to see how ZOLL's solutions can help improve the clinical and operational performance of your business.

MBI Lookup

The ZOLL® AR Boost®
MBI Lookup Tool Makes It Easy
to Find a Patient's MBI

Example Medicare Health Insurance Card

What is a Medicare Beneficiary Identifier (MBI)?

As of January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) requires Medicare Beneficiary Identifiers (MBIs) to be used for all Medicare transactions such as billing, claim submissions, and appeals. The 11-character patient identification numbers replace the social security number-based health insurance claim numbers (HICNs) previously used for Medicare patients.

Medicare will reject claims and transactions that fail to use MBIs. If you are not using MBIs on current claims, you will get the following electronic claims rejection codes:

  • A Claims Status Category Code of A7 (acknowledgment rejected for invalid information)
  • A Claims Status Code of 164 (entity’s contract/member number)
  • An Entity Code of IL (subscriber)

Paper claims that fail to use the MBI can anticipate the following rejection notices:

  • Claim Adjustment Reason Code (CARC) 16 “Claim/service lacks information or has submission/billing error(s)”
  • Remittance Advice Remark Code (RARC) N382 “Missing/incomplete/invalid patient identifier”
Healthcare worker explaining form to older male patient

Who is affected?

Every healthcare provider, physician, and supplier that submits claims to the Medicare Administrative Contractors (MACs) for services rendered to Medicare beneficiaries must use MBIs.

How is the MBI formatted?

The MBI number is a string of 11 randomly generated numbers and upper-case letters, excluding B, I, L, O, S, and Z to prevent confusion with similar-looking numbers. There are no hyphens or spaces in these sequences. If you include hyphens in your claim, it could be rejected. MBIs are sometimes shown with hyphens — for example, on a Medicare card — strictly for ease of reading. You can visit cms.gov for more information on the format of an MBI.

Man in suit holding phone in hand with technology icons floating above it

Are there exceptions to the MBI requirement?

MBIs are required, with three exceptions:

  • Medicare appeals: When you file an appeal, you can choose whether to use an MBI or an HICN.
  • Checking the status of a claim: If you filed a claim before January 1, 2020, you can use an HICN to check the status of a claim. If you filed it after that date, you’ll have to use the MBI.
  • Span-date claims: Some providers submit single claims for services that span multiple days. These might include instances of inpatient treatment or home health. If the services rendered concluded before December 31, 2019, you may submit a claim using the HICN or the MBI.

How can providers quickly obtain MBI numbers?

ZOLL Data Systems has built an MBI lookup tool and converter to make it easy to find a patient’s MBI. Any provider or billing software vendor can automatically identify and convert an individual HICN or SSN to MBI. The MBI lookup tool accelerates what is otherwise a time-consuming, manual process. Automatic lookup facilitates clean claims and optimum reimbursement.

ZOLL Data Systems can also execute batch queries for all Medicare patients in your databases. Simply send a batch file containing each patient record, in Excel format, through our secure portal. We will run our proprietary, enhanced MBI lookup process and deliver updated MBI numbers for all valid HICN and/or SSN within 24 hours.

You can also obtain the MBI number using one of these three manual methods:1

  1. 1. 835 remittance files: An Electronic Remittance Advice (ERA), also known as an 835, is an electronic transaction that provides information about claim payments. Many practices and billing companies utilize these so that claim payments post to their systems automatically.
  2. 2. MBI lookup on the MAC website: You can visit a MAC website to look up the MBI you need or go to cms.gov to find your MAC’s website by name or state.
  3. 3. Medicaid may return the MBI on an eligibility response

Submit a MBI Discovery Batch Request Form

Save Time and Frustration With Automated MBI Lookup

Processing Medicare claims can be frustrating and labor-intensive. With the MBI lookup tool, it's easy to get clean claims out the door quickly and efficiently. If you’re using RescueNet® Billing Pro, ZOLL Billing, or ZOLL AR Boost® solutions, the MBI lookup tool is already built into your solution.

If you’re using non-ZOLL software, you can easily take advantage of our MBI lookup, Medicare eligibility, and Insurance Discovery tools. The tools can be integrated quickly and easily into any healthcare billing system or accessed via a secure web portal.

Ready to get started? Complete the contact request form on this page or call us at 800-474-4489.

1 These methods may not return accurate information in a timely manner and can affect reimbursement.

ZOLL Pulse Blog

Find out about the latest insights for EMS, Fire, Hospital, and AR Optimization.