The plant pigments called betalains are nutritionally safe polar compounds. They are subdivided into betaxanthins (having orange to yellow hues) and betacyanins (purple to red violet hues). Betacyanins change color with a change in pH, particularly in the range 6–8 and 9–11. Perishable foods like fish, chicken, beef, pork, and others tend to release total volatile base-nitrogen (TVB-N) during storage or deterioration, which leads to a change in the pH of pH-sensitive materials in the vicinity. pH-sensitive pigment-incorporated polymeric films with inherent active properties (or active/intelligent films) are increasingly being studied as an alternative to synthetic pH indicators to detect the accumulation of TVB-N by changing its color to indicate the stage of perishable food spoilage. There are many methods of developing such films under different conditions using different bio-based biodegradable polymer(s) and biocompatible plasticizer combinations. Among the reported methods, solution casting method has been the preferred one in most studies covered in this review. This method can be carried out under mild conditions. As such, betacyanins-incorporated polymeric films essentially require mild processing conditions because of their heat sensitivity, which will invariably affect the performance in food freshness monitoring. In this review, film fabrication parameters like temperature and duration of dissolution of polymers, plasticizer concentration, pH of the film-forming solution, film drying, and conditioning/aging, have been critically appraised based on the available literature. The lack of studies on the safety of active/intelligent films has been systematically highlighted in this review to focus future studies on this area.