Reason Code U5065

Description
Per the Common Working File (CWF), the Medicare Beneficiary Identifier (MBI) submitted on this claim is invalid. Please contact the beneficiary for the correct MBI number or you may use the MBI lookup tool available in eServices. Please make corrections and resubmit your claim.

Why the Reason Code Was Assigned
Reason code 31605 will assign correctly on a claim when the MBI submitted on the notice or claim is invalid or terminated. Only current MBIs will be accepted on claims, home health Notice of Admissions (NOAs) and hospice Notice of Elections (NOEs).

Invalid or terminated MBIs submitted on an NOA or NOE may cause them to be late and receive a late submission penalty. The Parts A and B Medicare Administrative Contractors (MACs) will not grant exceptions based on MBI changes that were accessible to the home health agency or hospice more than two weeks prior to the admission date.

Resolution
It is important to verify patient eligibility prior to admission and prior to billing. Submitting the appropriate MBI based on the effective date of issuance and the dates of service being billed will help avoid claim edits and ensure proper billing and efficient processing.

Palmetto GBA’s eServices offers two tools to verify a beneficiary’s MBI is current.

• The "MBI End Date" field in the Eligibility tab
• The MBI Lookup tool

For more detail on using these tools and billing guidance when an MBI changes, please see the article Home Health and Hospice Billing When a New Medicare Beneficiary Identifier Is Assigned.

Resources

• eServices User Manual (PDF)
• Medicare Beneficiary Identifiers (MBIs)
• CMS Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 10, Home Health Agency Billing, Section 40.1, Notice of Admission (NOA) (PDF)
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 11, Processing Hospice Claims, Section 20.1.1, Notice of Election (NOE), Hospice Medicare Claims Processing Manual (PDF)