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Nov 4, 2016 Financial Management Work Group Conference Call

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Conference Call Schedule

  • Occurs on Fridays, 1 PM Eastern
  • Phone Number: +1 770-657-9270 Participant Passcode: 686300# (alternative for US if the first number doesn't work: +1 888-321-4501)- online meeting @


Member Name
Kathleen Connor Co-chair x
Beat Heggli Co-chair
Paul Knapp Co-chair .
John Moehrke Security Co-Chair
Lorraine Constable
Andy Stechishin
Mark Scrimshire
Grahame Grieve
Corey Spears
Mary Kay McDaniel
[mailto: DAYD@BCBSIL.COM Durwin Day] .
Lenel James .
Reed Gelzer .


  • Approval of Oct 28th agenda and the FM Oct 28th Call Minutes
  • Medicare Beneficiary Identifier (MBI) harmonization requirements - Mary Kay McDaniel (if available)
  • Review of FHIR Ballot Postponement rationale - Paul
  • v3 Invoice, BillableItem, ValuedItem, and Benefit CMET background for discussion on anesthesia use case for FHIR that Larry Cederberg raised.
  • Review of proposed Contract updates

==MBI Background==From: Buitendijk,Hans [1] Sent: Thursday, November 03, 2016 2:22 PM To: Mary Kay McDaniel <>; Kathleen Connor <>; Cc: 'Riki Merrick' <>;; 'W. Ted Klein' <>; Subject: RE: CMS Medicare Beneficiary Identifier

Agreed. The question is whether we expand the definition of Subscriber Number to include Medicare Beneficiary Identifier, whether to update IN2-6 to reflect that for the US this could contain the MBI (but how would you know it is the MBI being used or something else?), etc.

We already have three identifier types (MB, MC, SN) where one could conceivable put the MBI as a flavor, but that would not reveal whether the content of the identifier is following the MBI rules, or some other rules. Hence me leaning for now that a new identifier type would be most appropriate to start so wherever the CX data type is in play we have it covered, and then tackle the special scenarios like IN2-6 separately.

Whatever route is taken, the concept on how to resolve it should be consistent across V2, V3, and FHIR.

Hans J. Buitendijk, M.Sc., FHL7 | Sr. Strategist Standards & Regulations | | +1 610-219-2087 office | +1 484-354-6474 mobile | Cerner Corporation |

From: Mary Kay McDaniel [2] Sent: Thursday, November 3, 2016 16:53 To: Buitendijk,Hans <>; Kathleen Connor <>; Cc: 'Riki Merrick' <>;; 'W. Ted Klein' <>; Subject: Re: CMS Medicare Beneficiary Identifier

Hi all, Yes Hans, I think that there may or 'will' need to be a new Code Source. But I'm not sure where the impact actually is.

So, to that end, here are some things I know and some assumptions (which could be entirely wrong!!!) Known: - The existing HICN or HIC is composed of a SSN and additional alpha characters. There is no guarantee it is the SSN of the patient. - The HIC/N and the Railroad Retirement Board (RR identifier are being replaced with the Medicare Beneficiary Identifier (MBI), for billing Medicare - The MIB will appear in all transactions in the same data element as the HIC/N - The MBI will be the "subscriber identifier" for billing Medicare - CMS Medicare will covert the MBI to a HICN or HICN to the MBI - Characteristics of the MBI - Unique to each beneficiary - Will change ONLY due to Identity fraud (may be others reasons identified) - NO embedded intelligence - 11 positions long, only A/N, no special characters. Positions 2, 5, 8, 9 will always contain capitalized alpha characters, excluding B I L O S Z - Cards containing the new MBI must be mailed out (by CMS and the RR by April 2019. The new cards will have a different look. - Removing the gender AND signature line - CMS processes will be updated and ready to receive the MBI as of 4/1/2018 - Either ID will be accepted and processed 4/1/2018 - 12/31/2019 - Assumptions: - Provider's will continue to capture the SSN for whatever reasons they capture it today, i.e., credit situations, bad debt) - Patient Identifiers used within a provider system will continue to be the same identifiers used today

Additional information: SSNRI home - Centers for Medicare & Medicaid Services A federal government website managed by the Centers for Medicare & Medicaid Services 7500 Security Boulevard, Baltimore, MD 21244

Questions: Besides the PID and the IN2 - where would this ID be used???

IF the MBI is technically the 'subscriber id', it seems that the PID and the IN2 are OK??? Am I missing anything here??? V2: Chpt 6: Financial Management IN2 - 6: ST 00477 Medicare Health Insurance Number IN2-26: CX 00497 Payer Subscriber ID V2: Chpt 16; eClaims PID - 26 Table #0203. Identifier Type Code. MB Member Number An identifier for the insured of an insurance policy (this insured always has a subscriber), usually assigned by the insurance carrier. Use Case: Person is covered by an insurance policy. This person may or may not be the subscriber of the policy.

MC Patient's Medicare number Class: Insurance SN Subscriber Number Class: Insurance An identifier for a subscriber of an insurance policy which is unique for, and usually assigned by, the insurance carrier. Use Case: A person is the subscriber of an insurance policy. The person’s family may be plan members, but are not the subscriber.

SS Social Security number


  • Chair - TBD
  • FHIR FM FHIR Ballot Postponement Discusson - Paul
  • Kathleen and Paul discussed updates to Contract.
  • v3 Invoice, BillableItem, ValuedItem, and Benefit CMET background for discussion on anesthesia use case for FHIR that Larry Cederberg raised. Kathleen will add to next call agenda.
  • Meeting adjourned