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Anthem Blue Cross : Anthem SmartValue Private Fee for Services (PFFS)

Anthem SmartValue Private Fee for Services (PFFS)

Plan & Administrative Changes/Updates for Providers:
We will continue to provide PFFS run- out services for 2011 dates of service through 12/31/12. For original claims, providers have one year from the date of service to submit a claim for processing. Provider submitted adjustment (determination) requests, for PFFS providers, will be accepted up to one year from the original claim processing date or the date of the most recent claim determination. 
Click here for important Medicare Advantage updates!  
SmartValue from Anthem Blue Cross is a family of innovative Medicare Advantage Private Fee-for-Service plans available to Medicare beneficiaries in select areas and participation is easy:  
No contracting necessary for participation
Reimbursement based on Medicare allowable, see Payment Methodology
SmartValue works much the same way Original Medicare does.
SmartValue members are free to go to any hospital or to see any health care provider they choose, as long as the provider is eligible to receive Medicare payment and agrees to the SmartValue Terms and Conditions. See the Provider Disclosure/Terms & Conditions 2011 / Provider Discloser/Terms & Conditions 2010.
There are no referrals
SmartValue Plus members have a Medicare Part D prescription drug benefit as part of their plan.
Additional Information
Critical Access Hospital Billing & Reimbursement
EDI - 270/271 Eligibility Instructions
Providers (SNFs, Rehab Facilities and Home health Agencies) are responsible for issuing Notice of Non-Coverage Detailed Explanation of Non-Coverage letters. For more information and to down load templates of these letters, click here. Do NOT use the CMS template for the Notice of Medicare Non-Coverage (NMNC) found on the CMS website. Instead please contact the entity who made the determination for a branded copy of the form.
Institutional billing codes are available from the NUBC via the NUBC's Official UB-04 Data Specifications Manual. To be redirected to NUBC click here
ID Card
Medicare Advantage Private Fee For Service Claims Edits
Medicare Coverage Homepage
Medicare Part D Coverage Determination Request Form (for use by provider)
Optional PFFS Pre-Notification Fax Form
Affordable Care Act (ACA)
Formerly known as Patient Protection and Affordable Care Act
PFFS Contact Reference Guide
PFFS Fact sheet/FAQ
Pre-Determination Tip Sheet for Providers
PFFS Payment Dispute Request Form
PFFS Payment Reconsideration/Adjustment Form
Preventive Health Guidelines
Provider Independent Review Request
Quick Reference Guide to the CMS 1500
Request Form for Organizational Determinations
Revision of Definition of Compendium in the Medicare Benefit Policy Manual; Chapter 15; Section 50.4.5
2010 SmartValue Plan Details & Benefits
Click here for more information about SmartValue benefits, grievance and appeals, conditions and limitations, quality assurance and more.
SmartValue Provider Manual
Summary of Independent Review Process
Waiver of Liability Form
We want you to be sure you have no reservations about providing services to our members. We invite you to learn more about SmartValue.  

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Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.