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 perform an MBI lookup using their Social Security Number instead. Stedi returns a complete benefits response from CMS with the patient’s MBI in the subscriber object 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.

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Enrollment

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

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Perform an MBI Lookup

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

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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": "1234567890"
  },
  "subscriber": {
    "dateOfBirth": "19000101",
    "firstName": "Jane",
    "lastName": "Doe",
    "ssn": "123456789"
  }
}'

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Response

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

The following snippet shows part of a sample benefits response. In this scenario, the patient’s MBI is 1AA2CC3DD45.

Example MBI Lookup response
{
  {
  "meta": {
    "senderId": "030240928",
    "submitterId": "117151744",
    "applicationMode": "production",
    "traceId": "01J2VZA127GH93JT74HJU",
    "outboundTraceId": "01J2VZA127GH93JT74HJU"
  },
  "controlNumber": "214976898",
  "reassociationKey": "123456789",
  "tradingPartnerServiceId": "123456789",
  "provider": {
    "providerName": "ACME HEALTH SERVICES",
    "entityIdentifier": "Provider",
    "entityType": "Non-Person Entity",
    "npi": "1234567890"
  },
  "subscriber": {
    "memberId": "1AA2CC3DD45",
    "firstName": "JANE",
    "lastName": "DOE",
    "middleName": "A",
    "gender": "F",
    "entityIdentifier": "Insured or Subscriber",
    "entityType": "Person",
    "dateOfBirth": "19000101",
    "groupNumber": "123456789",
    "address": {
      "address1": "1234 FIRST ST",
      "city": "NEW YORK",
      "state": "WV",
      "postalCode": "123451111"
    }
  }
}

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