BlueMedicare PFFS

Blue Cross and Blue Shield of Florida (BCBSF) is offering Medicare beneficiaries a new Medicare Advantage Private Fee-for-Service plan, BlueMedicare PFFS. Individuals enrolled in employer group sponsored plans may also be offered BlueMedicare Group PFFS. This innovative plan, available to individuals in Florida and to Florida employer groups with retirees across the country, allows physicians, hospitals and other health care providers to participate without the challenges of network and referral restrictions and eliminates the need for time-consuming balance billing of patients.

BlueMedicare PFFS combines the benefits of Medicare Parts A and B and includes additional services not covered by Original Medicare such as preventive services and prescription drug coverage. Members may see any health care provider that accepts the BlueMedicare PFFS Terms and Conditions of Payment (PDF).

Why should providers accept BlueMedicare PFFS members?

Providers who accept Original Medicare have many reasons to accept our new BlueMedicare PFFS members.

• You'll be promptly reimbursed at the same rate Medicare pays. For more information on reimbursement, please refer to the BlueMedicare PFFS Payment Methodology Grid (PDF).
• There's no member billing required. Simply collect a copayment at the time of visit - there's no coinsurance for your services.
• There's no signed participation agreement requirement.
• BlueMedicare PFFS has a dedicated, highly trained operations center staff, focused on educating prospective members and providers to ensure they understand the plan.
• You can rely on reimbursements backed by the reputation and financial strength you can trust.

Physician and Hospital PFFS Reference Guide

The Physician and Hospital PFFS Reference Guide is intended to assist health care providers in understanding how our Private Fee-for-Service plan works. In this guide, you'll find:

• Benefit information
• Important contacts
• Tips to filing your claims
• Reimbursement methodology
• Frequently asked questions
• Forms
• Window cling for your office use ("We Accept PFFS")
• and more

Physicians, hospitals and other health care providers were mailed a printed copy of this guide. However, if you did not receive a copy and would like one mailed to you, please call our PFFS Provider Contact Center at 1-800-727-2227 to request a copy.

BlueMedicare PFFS has a Medicare Advantage contract approved by the Centers for Medicare & Medicaid Services. Contracts are renewed annually and availability of coverage beyond the end of the current contract year is not guaranteed. A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. A doctor or hospital must agree to accept the plan's terms and conditions prior to providing health care services to a member, with the exception of emergencies. If a doctor or hospital does not agree to accept our payment terms and conditions, they may not provide health care services to the member, except in emergencies.