Medicare AdvantageAdministrativeMedium impact
Geisinger Gold Secure Rx (HMO D-SNP) members and Community HealthChoices
Geisinger Health Plan·PA·Pharmacy
Effective date
Jan 18, 2024
We identified it
Jul 29, 2026
Summary
Geisinger Gold Secure Rx (HMO D-SNP) members who have Community HealthChoices (CHC) as secondary Medicaid coverage can continue receiving care from all Geisinger providers for Medicare-covered services. Geisinger providers do not need CHC MCO participation to bill them as secondary insurers, and members do not need to switch their primary Medicare Advantage coverage to CHC. This clarifies billing and provider access for dual-eligible beneficiaries in Pennsylvania.
Action Required
Immediately: Billing team must update internal documentation and training to reflect that Geisinger providers can bill CHC MCO as secondary insurer WITHOUT requiring separate CHC MCO credentialing or participation agreements for Medicare-covered services. Update claim submission workflows to allow dual-claim processing (Geisinger Gold Secure Rx primary, CHC secondary) without requiring provider to be CHC-contracted. Train front desk and verification staff to confirm CHC enrollment status during patient registration. For questions, direct staff to call 800-498-9731 or reference Pennsylvania's Medicaid/Medicare billing guidance. Failure to process claims correctly may result in claim denials or payment delays for CHC members.