In 2026, the results of routine checks on patients’ Medicare eligibility have become unpredictable due to a sweeping set of security reforms from the Centers for Medicare & Medicaid Services (CMS).
CMS moved to tighten security across the program following a data breach that exposed the personal information of millions of beneficiaries and compounded years of existing Medicare fraud. Two changes in particular have reshaped how eligibility checks work today:
- New Medicare Beneficiary Identifiers (MBIs): CMS reissued brand-new MBIs to more than a million members whose information may have been compromised.
- A new provider attestation process: Providers must now formally attest with their Medicare Administrative Contractor (MAC) to provide consent for clearinghouses to run Medicare eligibility on their behalf.
While well-intentioned, the downstream effect of these measures has been cumbersome: Providers and patient service groups are running into failed transactions, resulting in unknown coverage and delays to treatment for patients.
At Infinitus, we’ve rolled out a series of changes to our Medicare offering built specifically to absorb this new complexity. Here’s what you need to know:
MBI discovery when the one on file is invalid
What’s happening now: When CMS issues MBIs, it goes directly to the member, not to the provider or the patient service team working their case. In practice, that means providers are rarely notified, and the MBI sitting in their system is often the old, now-invalid one.
Without a valid MBI, eligibility transactions fail because of inadequate requirements. Furthermore, obtaining the latest MBI directly from members can be difficult, as not every member is easy to reach by phone or online.
The Infinitus solution: When our system encounters an invalid MBI, we automatically look up the member’s latest MBI through an integrated discovery tool. If a valid MBI is found, we immediately re-run the Medicare eligibility check and return the complete result to our customer along with the newly discovered MBI. This ensures customers’ records stay current for future reference.
Multiple clearinghouse integrations
What’s happening now: In the lead-up to the May Attestation deadline, providers were flooded with outreach from different organizations, each asking them to attest a different HETS ID, the identification number assigned by CMS to third-party entities.
Through internal benchmark testing, we found wide variation in how providers had attested across multiple clearinghouses: some had attested with all, others with just one or the other, and attestation rate was far from consistent across each clearinghouse.
The Infinitus solution: Rather than depend on a single clearinghouse, Infinitus integrates with multiple clearinghouses to widen the attestation surface area. If one clearinghouse fails to return a result, we automatically try another. The more paths available, the more likely an eligibility check succeeds on the first attempt.
Running eligibility checks with both provider and practice NPI
What’s happening now: Providers are busy treating patients. Administrative work, including attestation, competes for whatever time is left, and it usually loses to higher priority patient care.
One behavior we observed makes a real difference here: providers tend to attest under their practice’s NPI rather than their own individual NPI. This is because providers tend to bill under the practice NPI so that attestation only has to be done once for the entire site of care, making the process less burdensome for the others.
The Infinitus solution: Rather than resorting to the provider’s individual NPI, Infinitus runs Medicare eligibility with both the individual provider’s NPI and the practice NPI to account for this behavior. For customers who supply the practice NPI, we’ve seen a 50% increase in the success rate of Medicare eligibility transactions.
Closing thoughts
Healthcare doesn’t stand still and neither do we. Changes in regulatory policies can ripple outward, transforming something as fundamental as an eligibility check and negatively affecting various healthcare entities. Infinitus is committed to adapting just as quickly, so our customers always get the data they need to put patients on life-saving therapy.
The changes mentioned above have ultimately restored Medicare eligibility success rates to where they stood before the CMS policy changes took effect, turning a disruptive 2026 into business as usual for the teams who count on us.
If you’re running into any of the challenges outlined above when verifying benefits for Medicare patients, reach out to our team. We’re happy to walk through how these fixes could apply to your specific eligibility workflows.
