NPAG Webinar October 17, 2017

Transcription

1 NPAG Webinar October 17, 2017 SSN removal 1

2 AGENDA CMS Overview on New Medicare Card Project CMS website links for more detailed information BSCA project share Cambia project share Open Plan Share on other blues projects Open Discussion/Questions for other blues plans etc. What is SSNRI?... What is MBI? WHEN? 2

3 SSN removal Legislation requires that CMS mail out new Medicare cards with a new 11-byte Medicare Beneficiary Identifier (MBI) by April 2019 SSN removal 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.) Why is CMS issuing new Medicare cards and new Medicare numbers? The law requires the Centers for Medicare & Medicaid Services (CMS) to remove Social Security numbers (SSNs) from all Medicare cards by April A new unique Medicare number will replace the current Health Insurance Claim Number (HICN) on the new Medicare cards. We re taking this step to protect people with Medicare from fraudulent use of Social Security numbers, which can lead to identity theft and illegal use of Medicare benefits. 3

4 SSN removal The Medicare Beneficiary Identifier (MBI) solution for SSNRI must provide the following capabilities: 1. Generate MBIs for all beneficiaries: Includes existing active and deceased or archived beneficiaries as well as new beneficiaries. 2. Issue new, redesigned Medicare cards: New cards containing the MBI mailed to existing and new beneficiaries 3. Modify systems and business processes: Required updates to accommodate receipt, transmission, display, and processing of the MBI CMS will use a MBI generator to: Assign 150 million MBIs in the initial enumeration (60 million active and 90 million deceased/archived) and generate a unique MBI for each new Medicare beneficiary Generate a new unique MBI for a Medicare beneficiary whose identity has been compromised Medicare Beneficiary Identifier ~Characteristics~ The Medicare Beneficiary Identifier will have the following characteristics: The same number of characters as the current HICN (11), but will be visibly distinguishable from the HICN Contain uppercase alphabetic and numeric characters throughout the 11 digit identifier Occupy the same field as the HICN on transactions Be unique to each beneficiary (e.g. husband and wife will have their own MBI) Be easy to read and limit the possibility of letters being interpreted as numbers (e.g. Alphabetic characters are upper case only and will exclude S, L, O, I, B, Z) Not contain any embedded intelligence or special characters Not contain inappropriate combinations of numbers or strings that may be offensive CMS anticipates that the MBI will not be changed for an individual unless (1) the MBI is compromised or (2) for other limited circumstances, which are still undergoing review 4

5 Medicare Beneficiary Identifier (MBI) ~ Format~ Pos Type C A AN N A AN N A A N N C = Numeric 1 9 N = Numeric 0 9 A = Alphabetic characters (A Z) excluding (S, L, O, I, B, Z) AN = Either A or N ***note: alphabetic characters are Upper Case only Position 1 numeric values 1 9 Position 2 - alphabetic characters (A Z) minus (S, L, O, I, B, Z) Position 3 alpha-numeric values 1 9, and (A Z) minus(s, L, O, I, B, Z) Position 4 numeric values 0 9 Position 5 - alphabetic characters (A Z) minus (S, L, O, I, B, Z) Position 6 - alpha-numeric values 1 9, and (A Z), minus (S, L, O, I, B, Z) Position 7 numeric values 0 9 Position 8 - alphabetic characters (A Z) minus (S, L, O, I, B, Z) Position 9 - alphabetic characters (A Z) minus (S, L, O, I, B, Z) Position 10 numeric values 0 9 Position 11 numeric values SSN removal Transition Period The transition period will run from April 2018 through December 31, Globally, CMS will complete its system and process updates to be ready to accept and return the MBI on April 1, 2018 All stakeholders who submit or receive HIPAA electronic transactions containing the HICN must modify their processes and systems to be ready to submit or exchange the MBI by April 1, Stakeholders may submit either the MBI or HICN during the transition period. CMS will accept, use for processing, and return to stakeholders either the MBI or HICN, based upon whichever identifier is submitted during the transition period In addition, beginning October 2018 through the end of the transition period, when a HICN is submitted on Medicare fee-forservice claims, both the HICN and the MBI will be returned on the Medicare remittance advice 5

6 Medicare Beneficiary Identifier (MBI) Implementation Timeframes New MBI Card Issuance CMS will begin issuing new Medicare cards in April 2018 for existing beneficiaries after the initial enumeration of MBIs; cards will be mailed to roughly 60 million beneficiaries The gender and signature line will be removed from the new Medicare cards. The Railroad Retirement Board will issue its new cards to RRB beneficiaries CMS will work with States that currently include the HICN as Medicare ID on Medicaid cards to remove the Medicare ID or replace it with a MBI CMS will conduct education and outreach to all Medicare beneficiaries and their agents to help prepare for this change 6

7 CMS FAQs Visit the New Medicare Card Home webpages for the latest details about the transition at: Providers: Health Plans: Plans/Health-and-drug-plans.html Partners and Employers: Employers/Partners-and-employers.html Scope Use CMS crosswalk to update Medicare ID on member records in transactional systems Support HICN or MBI or Both on vendor & trading partner extracts Support HICN or MBI or Both in data marts Process HICN-MBI monthly CMS crosswalk files for new enrollees Develop solutions for MAPD, PDP, Med Supp and Federal & Commercial Medicare Members Challenges Late details from CMS Lack of details from Application Management vendor on member enrollment management specifically members who have not yet received a new card and are enrolling with a HICN Historical lookups where HICN was the primary key Storing and accessing MBIs for terminated and deceased members Trading partners not prepared to discuss requirements 7

8 Scope Prioritized remediation, focused first on member management system and process remediation Creation of Cambia Crosswalk that will be used to correlate MBI with other member identifiers known for lookups/reporting by dates of service Challenges Lack of urgency internally and externally to remediate when implementation runway so long Potential impact to sending one data element (HICN or MBI) and receiving different data element back (MBI or HICN) Historical image lookups Updating terminated member data 8

9 Open Plan Share Do you carry 2 fields for both HICN and MBI on our Members.? How do you intend to use the crosswalks? When do you plan to update your systems with the new MBI s? 9