The Advantage Plan from Medical Mutual (PFFS)
Medical Mutual is now offering groups and individuals the option of selecting a Medicare Advantage private fee-for-service (PFFS) plan, with coverage beginning January 1, 2008. This PFFS plan is an ‘open network’ plan, meaning enrollees can choose to seek services from any licensed provider who is eligible to receive payment from Medicare.
Enrollees must inform a provider prior to obtaining services that they have purchased Advantage Plan PFFS for their Medicare coverage. This gives the provider the right to accept the terms and condition of payment on a patient-by-patient and visit-by-visit basis. If a provider chooses to treat the enrollee, the provider is considered deemed, and has inherently agreed to our terms and conditions of payment and must bill Medical Mutual for covered health care services.
Advantages of Becoming a Deemed Provider
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No contract, credentialing or waiting is required to provide services to our enrollees.
- Continuity of care for your current patients who enroll in our PFFS program.
- Medicare rules of payment are followed.
- You become deemed when choosing to see our members, which gives you the right to accept Advantage Plan PFFS enrollees on a preferred patient-by-patient and visit-by-visit basis.
If you decide not to accept the terms and conditions of payment then you should not provide services to an enrollee, except for urgent or emergent situations. If you choose to treat an enrollee without accepting the terms and conditions, or the enrollee insists on receiving services from you as a non-deemed provider, you are responsible for securing written authorization from the enrollee to receive the service. You must inform the enrollee in writing prior to treating the patient that they will be financially responsible for all charges related to treatment. In these circumstances, do not submit a claim to Medical Mutual.
Resources for The Advantage Plan from Medical Mutual
Resources for The Private Fee-for-Service Plan