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 Private Fee For Service Plan
SmartValue from Blue Cross and Blue Shield of Georgia (BCBSGa) is an innovative new plan available to Medicare beneficiaries in select areas that are easy to participate in:
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 payment by Medicare and agrees to the SmartValue Plan's Terms and Conditions.
Members of the SmartValue Plus plan have a Medicare Part D prescription drug benefit as part of the plan. See Our Drug List.
You simply send claims to SmartValue instead of Medicare.
You'll be reimbursed according to the current Medicare Allowable Fee Schedule for your area**. For more information on how we calculate reimbursement rates, please see the SmartValue Payment Methodology Grid.
FAST TRACK APPEALS
Medicare beneficiaries and providers have certain rights and protections related to financial liability under the Medicare Advantage (MA) Programs. Financial liability, appeal rights, and protections are communicated to beneficiaries through notices given by providers or the MA health plan. Download the forms and instructions below.
We want to be sure you have no reservations about providing services to our members. We invite you to learn more about SmartValue by reading our Frequently Asked Questions.
You can call 1-866-364-2374 for more information about the Private Fee-For-Service Plan.
* The Summary of Benefits booklet, Provider Disclosure form and Provider Manual are in the PDF format. In order to view and print these documents, you must have Adobe Acrobat Reader. This software is available for FREE from the Adobe Acrobat Web Site. Click the icon below to verify that your version of Acrobat Reader is the most current version available. Please note that BCBSGa does not provide Technical Support for Acrobat Reader Software. For technical support, contact Adobe.
** Less the Member copayment amount. The copayment schedule is included in our Summary of Benefits.