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member mbi

mbr_mbi
member·Updated Jun 23, 2026

Definition

ISO-11179 Definition

The Medicare Beneficiary Identifier assigned to each Medicare beneficiary by CMS as the primary Medicare identification number, replacing the Social Security Number-based Health Insurance Claim Number in 2019. The MBI is an 11-character alphanumeric code with a defined format: character 1 is a non-SSN digit, characters 2 and 3 are letters, character 4 is a digit, character 5 is a letter, characters 6 and 7 are digits, character 8 is a letter, character 9 is a digit, character 10 is a letter, and character 11 is a digit. The MBI is used in Medicare claims submission, eligibility verification, and CMS enrollment files.

Healthcare data teams store mbr_mbi as VARCHAR(11) and validate against the CMS MBI format specification before loading into production systems.

Standard Abbreviation

mbr_mbi

Category

member

Production DDL — DIM_MEMBER

DIM_MEMBER.sql
CREATE OR REPLACE TABLE DIM_MEMBER (
    mbr_key           INTEGER        NOT NULL  -- surrogate key,
    mbr_id            VARCHAR(50)    NOT NULL  -- member identifier,
    mbr_first_nm      VARCHAR(100)             -- first name,
    mbr_last_nm       VARCHAR(100)             -- last name,
    mbr_birth_dt      DATE                     -- date of birth,
    mbr_gndr_cd       CHAR(1)                  -- gender code M/F/U,
    mbr_age           SMALLINT                 -- age in years,
    mbr_state_cd      CHAR(2)                  -- state code,
    mbr_zip_cd        VARCHAR(10)              -- zip code,
    mbr_elig_ind      BOOLEAN                  -- eligibility indicator,
    mbr_enrl_dt       DATE                     -- enrollment date,
    mbr_term_dt       DATE                     -- termination date,
    mbr_plan_cd       VARCHAR(20)              -- plan code,
    mbr_dual_elig_cd  VARCHAR(10)              -- dual eligibility code,
    load_dt           TIMESTAMP_NTZ  NOT NULL  -- load timestamp
);

Standard Snowflake DDL for the canonical member table. Convert to BigQuery or Databricks →

Why This Term Matters

Member and enrollment data governs who receives care and who pays for it — making it foundational to every downstream healthcare analytics workflow. Data engineers who understand member terminology build eligibility pipelines that prevent coverage gaps, correctly identify dual-eligible members, and support accurate risk adjustment submissions to CMS. Enrollment errors directly affect capitation payments and can trigger CMS corrective action plans.

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