A Medicare Beneficiary Identifier (MBI) is a unique, randomly-generated identifier assigned to individuals enrolled in Medicare. You must include the patient’s MBI in every eligibility check you submit to the Centers for Medicare and Medicaid Services (Payer ID: CMS).

When patients don’t know their MBI, you can use Stedi’s eligibility APIs to perform an MBI lookup using their Social Security Number instead. Stedi returns a complete benefits response from CMS containing the patient’s coverage status as well as their MBI for future reference.

There is an additional cost to perform MBI lookups with Stedi’s eligibility check APIs. Please contact Stedi customer support to enable access and add MBI lookups to your agreement.

​
Enrollment

Before you can perform MBI lookups, you must complete transaction enrollment for Payer ID: MBILU.

​
Perform an MBI Lookup

You can perform MBI lookups using Stedi’s Real-Time Eligibility Check and Batch Eligibility Check APIs.

​
Request

Construct an eligibility check request that includes the patient’s first name, last name, date of birth, and Social Security Number (SSN).

Set the tradingPartnerServiceId to MBILU. This is a special Payer ID that tells Stedi to perform an MBI lookup for the patient in addition to a standard eligibility check.

The following sample request performs an MBI lookup for a patient named Jane Doe.

Example MBI Lookup request
curl --request POST \
  --url https://healthcare.us.stedi.com/2024-04-01/change/medicalnetwork/eligibility/v3 \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --data '{
  "controlNumber": "123456789",
  "tradingPartnerServiceId": "MBILU",
  "externalPatientId": "UAA111222333",
  "encounter": {
    "serviceTypeCodes": [
      "30"
    ]
  },
  "provider": {
    "organizationName": "ACME Health Services",
    "npi": "1999999984"
  },
  "subscriber": {
    "dateOfBirth": "19000101",
    "firstName": "Jane",
    "lastName": "Doe",
    "ssn": "123456789"
  }
}'

​
Response

Stedi uses the patient’s demographic data and SSN to perform an MBI lookup. If there is a match, Stedi submits an eligibility check to CMS.

Stedi returns a complete benefits response from CMS for the patient and places the patient’s MBI in the subscriber.memberId property.

The following example shows a CMS benefits response returned from an MBI lookup. In this scenario, the patient’s MBI is 1AA2CC3DD45.

Example MBI Lookup response
{
    "meta": {
        "senderId": "STEDI",
        "submitterId": "117151744",
        "applicationMode": "production",
        "traceId": "11112222333344445555666677",
        "outboundTraceId": "11112222333344445555666677"
    },
    "controlNumber": "112233445",
    "reassociationKey": "112233445",
    "tradingPartnerServiceId": "CMS",
    "provider": {
        "providerName": "ACME HEALTH SERVICES",
        "entityIdentifier": "Provider",
        "entityType": "Non-Person Entity",
        "npi": "1999999984"
    },
    "subscriber": {
        "memberId": "1AA2CC3DD45",
        "firstName": "JANE",
        "lastName": "DOE",
        "middleName": "A",
        "gender": "F",
        "entityIdentifier": "Insured or Subscriber",
        "entityType": "Person",
        "dateOfBirth": "19000101",
        "address": {
            "address1": "1234 FIRST ST",
            "city": "NEW YORK",
            "state": "WV",
            "postalCode": "123451111"
        }
    },
    "payer": {
        "entityIdentifier": "Payer",
        "entityType": "Non-Person Entity",
        "name": "CMS",
        "payorIdentification": "CMS"
    },
    "planDateInformation": {
        "eligibility": "20241025"
    },
    "planStatus": [
        {
            "statusCode": "1",
            "status": "Active Coverage",
            "serviceTypeCodes": [
                "88"
            ]
        },
        {
            "statusCode": "1",
            "status": "Active Coverage",
            "serviceTypeCodes": [
                "30",
                "42",
                "45",
                "48",
                "49",
                "69",
                "76",
                "83",
                "A5",
                "A7",
                "AG",
                "BT",
                "BU",
                "BV"
            ]
        },
        {
            "statusCode": "1",
            "status": "Active Coverage",
            "serviceTypeCodes": [
                "30",
                "2",
                "23",
                "24",
                "25",
                "26",
                "27",
                "28",
                "3",
                "33",
                "36",
                "37",
                "38",
                "39",
                "40",
                "42",
                "50",
                "51",
                "52",
                "53",
                "67",
                "69",
                "73",
                "76",
                "83",
                "86",
                "98",
                "A4",
                "A6",
                "A8",
                "AI",
                "AJ",
                "AK",
                "AL",
                "BT",
                "BU",
                "BV",
                "DM",
                "UC"
            ]
        }
    ],
    "benefitsInformation": [
        {
            "code": "I",
            "name": "Non-Covered",
            "serviceTypeCodes": [
                "41",
                "54"
            ],
            "serviceTypes": [
                "Routine (Preventive) Dental",
                "Long Term Care"
            ],
            "inPlanNetworkIndicatorCode": "W",
            "inPlanNetworkIndicator": "Not Applicable"
        },
        {
            "code": "1",
            "name": "Active Coverage",
            "serviceTypeCodes": [
                "88"
            ],
            "serviceTypes": [
                "Pharmacy"
            ],
            "inPlanNetworkIndicatorCode": "W",
            "inPlanNetworkIndicator": "Not Applicable"
        },
        {
            "code": "R",
            "name": "Other or Additional Payor",
            "insuranceTypeCode": "QM",
            "insuranceType": "Qualified Medicare Beneficiary",
            "planCoverage": "CA QMB Plan",
            "inPlanNetworkIndicatorCode": "W",
            "inPlanNetworkIndicator": "Not Applicable",
            "benefitsDateInformation": {
                "coordinationOfBenefits": "20230101"
            }
        },
        {
            "code": "1",
            "name": "Active Coverage",
            "serviceTypeCodes": [
                "30",
                "42",
                "45",
                "48",
                "49",
                "69",
                "76",
                "83",
                "A5",
                "A7",
                "AG",
                "BT",
                "BU",
                "BV"
            ],
            "serviceTypes": [
                "Health Benefit Plan Coverage",
                "Home Health Care",
                "Hospice",
                "Hospital - Inpatient",
                "Hospital - Room and Board",
                "Maternity",
                "Dialysis",
                "Infertility",
                "Psychiatric - Room and Board",
                "Psychiatric - Inpatient",
                "Skilled Nursing Care",
                "Gynecological",
                "Obstetrical",
                "Obstetrical/Gynecological"
            ],
            "insuranceTypeCode": "MA",
            "insuranceType": "Medicare Part A",
            "inPlanNetworkIndicatorCode": "W",
            "inPlanNetworkIndicator": "Not Applicable",
            "benefitsDateInformation": {
                "plan": "20190101"
            },
            "additionalInformation": [
                {
                    "description": "0-Beneficiary insured due to age OASI"
                }
            ]
        },
        {
            "code": "C",
            "name": "Deductible",
            "serviceTypeCodes": [
                "30"
            ],
            "serviceTypes": [
                "Health Benefit Plan Coverage"
            ],
            "insuranceTypeCode": "QM",
            "insuranceType": "Qualified Medicare Beneficiary",
            "planCoverage": "Medicare Part A",
            "timeQualifierCode": "26",
            "timeQualifier": "Episode",
            "benefitAmount": "0",
            "inPlanNetworkIndicatorCode": "W",
            "inPlanNetworkIndicator": "Not Applicable",
            "benefitsDateInformation": {
                "plan": "20240101-20241231"
            }
        },
        {
            "code": "1",
            "name": "Active Coverage",
            "serviceTypeCodes": [
                "30",
                "2",
                "23",
                "24",
                "25",
                "26",
                "27",
                "28",
                "3",
                "33",
                "36",
                "37",
                "38",
                "39",
                "40",
                "42",
                "50",
                "51",
                "52",
                "53",
                "67",
                "69",
                "73",
                "76",
                "83",
                "86",
                "98",
                "A4",
                "A6",
                "A8",
                "AI",
                "AJ",
                "AK",
                "AL",
                "BT",
                "BU",
                "BV",
                "DM",
                "UC"
            ],
            "serviceTypes": [
                "Health Benefit Plan Coverage",
                "Surgical",
                "Diagnostic Dental",
                "Periodontics",
                "Restorative",
                "Endodontics",
                "Maxillofacial Prosthetics",
                "Adjunctive Dental Services",
                "Consultation",
                "Chiropractic",
                "Dental Crowns",
                "Dental Accident",
                "Orthodontics",
                "Prosthodontics",
                "Oral Surgery",
                "Home Health Care",
                "Hospital - Outpatient",
                "Hospital - Emergency Accident",
                "Hospital - Emergency Medical",
                "Hospital - Ambulatory Surgical",
                "Smoking Cessation",
                "Maternity",
                "Diagnostic Medical",
                "Dialysis",
                "Infertility",
                "Emergency Services",
                "Professional (Physician) Visit - Office",
                "Psychiatric",
                "Psychotherapy",
                "Psychiatric - Outpatient",
                "Substance Abuse",
                "Alcoholism",
                "Drug Addiction",
                "Vision (Optometry)",
                "Gynecological",
                "Obstetrical",
                "Obstetrical/Gynecological",
                "Durable Medical Equipment",
                "Urgent Care"
            ],
            "insuranceTypeCode": "MB",
            "insuranceType": "Medicare Part B",
            "inPlanNetworkIndicatorCode": "W",
            "inPlanNetworkIndicator": "Not Applicable",
            "benefitsDateInformation": {
                "plan": "20190101"
            },
            "additionalInformation": [
                {
                    "description": "0-Beneficiary insured due to age OASI"
                }
            ]
        },
        {
            "code": "C",
            "name": "Deductible",
            "serviceTypeCodes": [
                "30"
            ],
            "serviceTypes": [
                "Health Benefit Plan Coverage"
            ],
            "insuranceTypeCode": "QM",
            "insuranceType": "Qualified Medicare Beneficiary",
            "planCoverage": "Medicare Part B",
            "timeQualifierCode": "23",
            "timeQualifier": "Calendar Year",
            "benefitAmount": "0",
            "inPlanNetworkIndicatorCode": "W",
            "inPlanNetworkIndicator": "Not Applicable",
            "benefitsDateInformation": {
                "plan": "20240101-20241231"
            }
        },
        {
            "code": "A",
            "name": "Co-Insurance",
            "serviceTypeCodes": [
                "30"
            ],
            "serviceTypes": [
                "Health Benefit Plan Coverage"
            ],
            "insuranceTypeCode": "QM",
            "insuranceType": "Qualified Medicare Beneficiary",
            "planCoverage": "Medicare Part B",
            "timeQualifierCode": "27",
            "timeQualifier": "Visit",
            "benefitPercent": "0",
            "inPlanNetworkIndicatorCode": "W",
            "inPlanNetworkIndicator": "Not Applicable",
            "benefitsDateInformation": {
                "plan": "20240101-20241231"
            }
        },
        {
            "code": "R",
            "name": "Other or Additional Payor",
            "serviceTypeCodes": [
                "88"
            ],
            "serviceTypes": [
                "Pharmacy"
            ],
            "insuranceTypeCode": "OT",
            "insuranceType": "Other",
            "inPlanNetworkIndicatorCode": "W",
            "inPlanNetworkIndicator": "Not Applicable",
            "benefitsAdditionalInformation": {
                "planNumber": "A0505",
                "planNetworkIdNumber": "555"
            },
            "benefitsDateInformation": {
                "benefit": "20230101"
            },
            "benefitsRelatedEntity": {
                "entityIdentifier": "Payer",
                "entityType": "Non-Person Entity",
                "entityName": "UHC OF CALIFORNIA",
                "address": {
                    "address1": "202 Main St",
                    "city": "Sacramento",
                    "state": "CA",
                    "postalCode": "94203"
                },
                "contactInformation": {
                    "contacts": [
                        {
                            "communicationMode": "Telephone",
                            "communicationNumber": "8006446644"
                        },
                        {
                            "communicationMode": "Uniform Resource Locator (URL)",
                            "communicationNumber": "UHC.com/Medicare"
                        }
                    ]
                }
            },
            "benefitsRelatedEntities": [
                {
                    "entityIdentifier": "Payer",
                    "entityType": "Non-Person Entity",
                    "entityName": "UHC OF CALIFORNIA",
                    "address": {
                        "address1": "202 Main St",
                        "city": "Sacramento",
                        "state": "CA",
                        "postalCode": "94203"
                    },
                    "contactInformation": {
                        "contacts": [
                            {
                                "communicationMode": "Telephone",
                                "communicationNumber": "8006446644"
                            },
                            {
                                "communicationMode": "Uniform Resource Locator (URL)",
                                "communicationNumber": "UHC.com/Medicare"
                            }
                        ]
                    }
                }
            ]
        },
        {
            "code": "U",
            "name": "Contact Following Entity for Eligibility or Benefit Information",
            "serviceTypeCodes": [
                "30"
            ],
            "serviceTypes": [
                "Health Benefit Plan Coverage"
            ],
            "insuranceTypeCode": "HN",
            "insuranceType": "Health Maintenance Organization (HMO) - Medicare Risk",
            "inPlanNetworkIndicatorCode": "W",
            "inPlanNetworkIndicator": "Not Applicable",
            "benefitsAdditionalInformation": {
                "planNumber": "A0505",
                "planNetworkIdNumber": "555"
            },
            "benefitsDateInformation": {
                "coordinationOfBenefits": "20230101"
            },
            "benefitsRelatedEntity": {
                "entityIdentifier": "Primary Payer",
                "entityType": "Non-Person Entity",
                "entityName": "UHC OF CALIFORNIA",
                "address": {
                    "address1": "202 Main St",
                    "city": "Sacramento",
                    "state": "CA",
                    "postalCode": "94203"
                },
                "contactInformation": {
                    "contacts": [
                        {
                            "communicationMode": "Telephone",
                            "communicationNumber": "8006446644"
                        },
                        {
                            "communicationMode": "Uniform Resource Locator (URL)",
                            "communicationNumber": "UHC.com/Medicare"
                        }
                    ]
                }
            },
            "benefitsRelatedEntities": [
                {
                    "entityIdentifier": "Primary Payer",
                    "entityType": "Non-Person Entity",
                    "entityName": "UHC OF CALIFORNIA",
                    "address": {
                        "address1": "202 Main St",
                        "city": "Sacramento",
                        "state": "CA",
                        "postalCode": "94203"
                    },
                    "contactInformation": {
                        "contacts": [
                            {
                                "communicationMode": "Telephone",
                                "communicationNumber": "8006446644"
                            },
                            {
                                "communicationMode": "Uniform Resource Locator (URL)",
                                "communicationNumber": "UHC.com/Medicare"
                            }
                        ]
                    }
                }
            ],
            "additionalInformation": [
                {
                    "description": "MA Bill Option Code - A"
                }
            ]
        }
    ],
    "errors": [],
    "x12": "",
    "eligibilitySearchId": "0195390d-7a4b-7873-9632-56015fef76ab"
}

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