Medicare AdvantageBilling CodesHigh impact
No balance billing for Geisinger Gold Secure Rx patients
Geisinger Health Plan·Pharmacy·Pharmacy
Effective date
Jan 11, 2024
We identified it
Jul 29, 2026
Summary
Geisinger Gold Secure Rx (a Medicare Advantage plan with integrated Medicaid) prohibits balance billing members for any amounts not covered by the plan. Billing teams must write off all patient balances after Geisinger Gold payment and may bill Medicaid as secondary without requiring Medicaid participation.
Action Required
Effective immediately (as of Jan 11, 2024): (1) Billing team must update all account collection policies to prohibit balance billing for Geisinger Gold Secure Rx members. (2) Configure billing system to automatically write off patient balances after Geisinger Gold payment for this plan population. (3) Implement secondary billing to Medicaid in the system without requiring Medicaid provider participation verification. (4) Train collections and patient financial services staff to inform Geisinger Gold Secure Rx patients that they have no financial liability beyond plan payment. (5) Audit existing outstanding balances from Geisinger Gold Secure Rx members and process retroactive write-offs. Failure to comply may result in regulatory violations and improper collections from beneficiaries.