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High-dollar claims and split billing requirements
Act
immediately
Effective date
Not stated in the notice
Identified
Aug 5, 2026
Summary
Geisinger Gold (Medicare Advantage) now requires claims exceeding $99,999.99 to be split into multiple submissions with modifier 76 on subsequent claims and specific narrative documentation. High-cost services like drugs, hemophilia clotting factors, and skin substitutes must follow strict split-billing procedures to avoid rejections and duplicate denials.
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What to do
immediately · 7 steps
01Billing team must implement split-billing procedures for all Geisinger Gold (Medicare Advantage) claims exceeding $99,999.99.
02Update billing software validation rules to flag claims over $99,999.99 for mandatory splitting.
03Configure system to automatically apply modifier 76 to all subsequent claim submissions after the first.
04Establish workflow requiring billing staff to include mandatory narratives: 'Claim 1 of X, dollar amount exceeds charge line amount' in CMS 1500 form item 19 or electronic claim loop 2400 segment NTE02 (NTE01=ADD) for first claims, and 'Claim 2 of X, remaining dollar amount, amount exceeds charge line amount' for subsequent claims.
05For drug billing, ensure administration codes are billed on first or second claim only, never both.
06Train all billing staff on these requirements before processing high-dollar claims for hemophilia clotting factors, skin substitutes, and other high-cost services.
07Establish internal audit process to verify each split claim has different total dollar amounts to prevent duplicate claim denials.
If missed: Failure to comply will result in claim rejections and denials.
Original notice
High-dollar claims and split billing requirements
geisinger.org · Always check the source before changing claims.