High-dollar claims and split billing requirements

Immediately: Billing team must implement split-billing procedures for all Geisinger Gold (Medicare Advantage) claims exceeding $99,999.99. (1) Update billing software validation rules to flag claims over $99,999.99 for mandatory splitting. (2) Configure system to automatically apply modifier 76 to all subsequent claim submissions after the first. (3) Establish 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. (4) For drug billing, ensure administration codes are billed on first or second claim only, never both. (5) Train all billing staff on these requirements before processing high-dollar claims for hemophilia clotting factors, skin substitutes, and other high-cost services. (6) Establish internal audit process to verify each split claim has different total dollar amounts to prevent duplicate claim denials. Failure to comply will result in claim rejections and denials.