Cooperative Exchange New Medicare Card Resources


CMS has indicated that the HETS system will not be returning the MBI in the 271 eligibility benefit response when the beneficiary has been issued their new number when the 270 is submitted with the beneficiary’s HICN.  Starting in June of 2018 providers will be able to look up a Medicare patient’s new Medicare number through their Medicare Administrative Contractor’s (MAC’s) secure web portal for the instances in which a beneficiary does not have a new Medicare card at the point of care. CMS believes this tool will give providers a mechanism to access a beneficiary’s MBI securely without disrupting workflow.  Additionally, CMS will be returning the MBI in the E1 NCPDP transaction [the pharmacy equivalent to the 270/271 transaction] if the HICN is submitted, this functionality is needed in the 270/271 transaction.

In reviewing the CMS operational goals as it relates to the MBI “lookup tool” that will be supported in the Medicare Administrative Contractor’s (MAC’s) secure web portal the Cooperative Exchange has identified issues that would increase the burden for providers, beneficiaries and business partners, including breaking of standard EDI workflow and increasing the administrative cost to the provider.

As a response to the concerns expressed by our membership the Cooperative Exchange has developed a template for any members who are concerned with this issue and would like a template to provide feedback and recommendations directly to CMS or to use the template to educate their provider and vendor partners on how to get involved. Additionally, The Cooperative Exchange has developed a cover letter and instructions on how to use the template.

Download Template CMS ELG Enhancement Request  

Download Cover Letter and Instructions

Click here to view the Cooperative Exchange’s feedback to CMS regarding the MBI transition concerns.