Medicare Patient Identifier

Data related to an individual’s insurance coverage for health care.

Data Element

Description

Medicare Beneficiary Identifiers (MBI) used to uniquely identify Medicare patients.

Submitted By: Joel Andress / Centers for Medicare and Medicaid Services (CMS) Center for Clinical Standards and Quality (CCSQ)
Data Element Information
Use Case Description(s)
Use Case Description	Medicare beneficiary identifiers (MBI) are a standard patient identifier for Medicare patients across the United States. These patient identifiers are submitted with patient-level data to CMS for quality measure reporting, both for eCQMs and for claims-based measures. Although an all-payer unique identifier is not yet available, Medicare beneficiary identifiers are fully standardized and available and assist with patient identification and matching, which is a good first step for patient identification.
Estimate the breadth of applicability of the use case(s) for this data element	All Medicare beneficiaries have an MBI and all 4,000+ hospitals and providers reporting measure data to CMS currently have access to and are required to report this patient identification information.
Link to use case project page	https://www.cms.gov/Medicare/New-Medicare-Card
Use Case Description	For providers responsible for the care of a patient population, the ability to transfer and share information from encounters with their Medicare beneficiaries from providers outside of their network supports optimal quality of care.
Estimate the breadth of applicability of the use case(s) for this data element	Hospital and outpatient providers participating in alternative payment models for Medicare beneficiaries, which is a growing stakeholder group.
Healthcare Aims	Improving patient experience of care (quality and/or satisfaction) Improving the health of populations Reducing the cost of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s)	MBI format specifications: https://www.cms.gov/Medicare/New-Medicare-Card/Understanding-the-MBI.pdf HL7 Identifier type value set, see MC (http://hl7.org/fhir/R4/v2/0203/index.html) https://www.cms.gov/Medicare/New-Medicare-Card/Understanding-the-MBI.pdf
Additional Specifications	HL7 FHIR US Core Implementation Guide STU3 based on FHIR R4, Patient Profile require a Patient ID. This profile already required to exchange other patient demographic information included in USCDI v1: https://www.hl7.org/fhir/us/core/StructureDefinition-us-core-patient.html
Current Use	This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
Supporting Artifacts	Patient Medicare identifiers routinely captured in EHR systems, claims data and is used by hospitals, providers, and other healthcare stakeholders for submission to CMS for quality measurement reporting. Widely available in EHR systems to support Patient FHIR resource: https://fhir.cerner.com/millennium/r4/individuals/patient/ https://fhir.epic.com/Specifications?api=932 https://developer.allscripts.com/FHIR?PageTitle=Resources https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Programs https://ecqi.healthit.gov/ecqms https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Programs
Extent of exchange	5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Supporting Artifacts	Medicare patient IDs electronically exchanged with CMS for quality measure reporting via QRDA files and other electronic exchange platforms; required as part of submission for Medicare beneficiaries included in the measures. Provider-payer data exchange and member-mediated information exchange are also occurring, and include FHIR Patient profile with a patient ID, being testing in HL7 Connectathons. https://ecqi.healthit.gov/qrda https://build.fhir.org/ig/HL7/davinci-ehrx/profiles.html https://ecqi.healthit.gov/qrda
Potential Challenges
Restrictions on Standardization (e.g. proprietary code)	Standard patient IDs only available for Medicare beneficiaries; no unique identifier for all-payer patients.
Restrictions on Use (e.g. licensing, user fees)	N/A
Privacy and Security Concerns	This data, like any patient data, should be exchanged securely. Current processes exist, governed by CMS and ONC, to securely transfer this data. MBI is a unique randomly generated ID with “non-intelligent” characteristics, which replaced the HIC Number, based on SSN.
Estimate of Overall Burden	No/low burden anticipated, as Medicare identifiers already in wide use among stakeholders caring for Medicare beneficiaries. Patient FHIR US Core profile also required by the US Core Capability Statement and required for exchange of other patient demographic data included in USCDI version 1; a patient ID is required for inclusion in this profile. Therefore, all stakeholders complying with ONC CEHRT requirements will have ID data ready for exchange in standards.
Other Implementation Challenges	N/A

ASTP Evaluation Details Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1 Maturity - Current Standards	Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2 Maturity - Current Use	Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3 Maturity - Current Exchange	Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4 Use Case(s) - Breadth of Applicability	Level 0 - Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.
Evaluation Comment	This data element represents a specific type of an existing USCDI data elements Member Identifier in the Health Insurance Information data class.

Comment

Submitted by rdillaire on 2025-05-12

CMS-CCSQ Supports Medicare Patient Identifier for USCDI v6

Recommendation 1: CMS CCSQ recommends advancing the Medicare Patient Identifier element to Level 2 and inclusion of the Coverage Period, Group Name, Payer Name, Plan Name, and Medicare Patient Identifier data elements in final USCDI v6.

Rationale: Inclusion of these common health insurance data elements for nationwide interoperability is essential for such use cases as value-based care, including affordability for lower-income individuals, and enabling patients to determine costs and affordability up front. This Health Insurance Information data class is associated with the overall primary and secondary coverage for the individual. In some cases, it may be different from the benefit used for a particular encounter or claim (e.g., worker's comp benefits). While these data elements are already included in the latest Fast Healthcare Interoperability Resources (FHIR) US Core and Consolidated Clinical Document Architecture (CDA) implementation guides (IGs) referenced in the Health, Data, Technology, and Interoperability-1 Final Rules (HTI-1), the implementation community can benefit from more clarity on how to consistently populate these fields—in particular Payer Name and Group Name—as there is variation between what a typical insurance card shows versus what is best used on real-time eligibility (RTE) queries with health plans.

Recommendation 2: CMS CCSQ recommends renaming and aligning Medicare Patient Identifier (MPI) with CMS’s naming and use of Medicare Beneficiary Identifier (MBI).

Submitted by BLampkins_CSTE on 2024-09-30

CSTE Comment - v6

CSTE supports inclusion of this data element in USCDI V6. Please see previously submitted CSTE comments for additional recommendations.

Submitted by BLampkins_CSTE on 2024-04-15

CSTE Comment - v5

This is one type of patient identifier and there are others which could all be subsumed under Patient Identifier, Patient Identifier type and Patient Identifier Assigning Authority.

Submitted by nedragarrett_CDC on 2024-04-15

CDC's Comment for draft USCDI v5

CDC supports the inclusion of this data element in USCDI v5 as it is an element that may be necessary for calculation of our digital quality metrics from FHIR data.

Submitted by nedragarrett_CDC on 2023-09-15

CDC's Consolidated Comment for USCDI v4

CDC continues to support inclusion of this data element in USCDIv5.
NAACCR Comment: This data element will be helpful for linkages for public health use and is part of NAACCR standard.

Submitted by nedragarrett_CDC on 2022-09-27

CDC's Consolidated Comment for USCDI v4

CDC continues to recommend inclusion of this high priority data element in USCDI v4

Submitted by nedragarrett_CDC on 2021-09-29

Unified Comment from CDC

NOTE - This comment supports the promotion of the Data Class Patient Demographics - Data Element Identifier to USCDI V3 as well as the additional Data Element of Identifier System, including the allowance of multiple instances of Identifier/ Identifier System per patient. We believe that this will allow needed flexibility to accommodate use and exchange of the variety of patient identifiers in current use in the US. An example of this approaches is: Identifier: 1A10B23CD45, Identifier System: http://hl7.org/fhir/sid/us-mbi. If ONC does not choose to incorporate this approach (Identifier + Identifier System) in USCDI V3, we recommend allowing for the following Patient Demographic Data Class Data Elements in USCDI V3: Medicare Patient Identifier, Medical Record Number and Social Security Number.
General Comment: We suggest changing this data element name from Medicare Patient Identifier to Medicare Beneficiary Identifier because that is what CMS and the Social Security Administration, as well as many health care industry stakeholders call it. (see: https://www.cms.gov/Medicare/New-Medicare-Card)
Additional Use Cases: The MedMorph Public Health Use Cases of Health Care Surveys and Cancer Registry Reporting are use cases that use Medicare Patient Identifier as an important patient identifier for internal registry and external to registry linking and patient or registrant identification or matching purposes. Links to Use Case Project Pages: https://www.cdc.gov/csels/phio/making-ehr-data-more-available.html, https://www.cdc.gov/nchs/dhcs/nhcs_registry_landing.htm, https://www.cdc.gov/cancer/npcr/
Additional Applicable Standards: HL7 CDA ® Release 2 Implementation Guide: Reporting to Public Health Cancer Registries from Ambulatory Healthcare Providers, Release 1, DSTU Release 1.1 – US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=398.
HL7 CDA® R2 Implementation Guide: National Health Care Surveys (NHCS), R1 STU Release 3 - US Realm: https://www.hl7.org/implement/standards/product_brief.cfm?product_id=385
HL7 FHIR® US Core Implementation Guide STU3 Release 3.1.1: https://www.hl7.org/fhir/us/core/index.html
CSTE supports inclusion of this measure into USCDI v3

Submitted by JAndress316 on 2021-04-16

Response to Comment on Medicare Patient Identifier

Specific Identifier(s) or general Identifier?
MedMorph supports the addition of Medicare Patient Identifier (level 2), but is concerned with having a general Identifier element (level 2) as well as Medical Record Number (Level 1) and Patient Social Security Number (level 1). What is the intention of Identifier - is it a placeholder for a national identifier of some sort for a patient? We recommend that USCDI either take a general approach with Identifier Type, Identifier System, and Identifier Value OR be specific with Medical Record Number, Medicare Patient Identifier and Social Security Number elements (and remove the Identifier element).

CMS's intent with the Medicare Patient Identifier data element submission was to specifically recommend inclusion of the Medicare Beneficiary Identifier (MBI) for Medicare beneficiaries, as this ID is currently well defined and captured.

Submitted by maria.michaels… on 2021-04-06

Specific Identifier(s) or general Identifier?

MedMorph supports the addition of Medicare Patient Identifier (level 2), but is concerned with having a general Identifier element (level 2) as well as Medical Record Number (Level 1) and Patient Social Security Number (level 1). What is the intention of Identifier - is it a placeholder for a national identifier of some sort for a patient? We recommend that USCDI either take a general approach with Identifier Type, Identifier System, and Identifier Value OR be specific with Medical Record Number, Medicare Patient Identifier and Social Security Number elements (and remove the Identifier element).

Submitted by nedragarrett_CDC on 2020-12-10

Recommendations for Updated Submission

We've reviewed and submitted feedback on the submission we've put forward for Patient Medicare Number, and we believe the information provided differs from the submission here, which has been referenced when told we submitted a duplicate. We believe our submission should be revisited as it differs in some areas to the submission seen here.