Learn more about submitting claims and rules for payment, including time frames for submitting, contesting or adjusting a claim as well as special guidelines for electronic and paper claim forms.
Review claim submission requirements for Blue Shield of California labs, specialty pharmacy and DME providers.
Special guidelines for CMS 1500 and UB-04 claims to help physicians submit these forms properly and process claims efficiently.
Review recent NCCI edits to physicians and hospital outpatient providers.
Read an overview of payment processing policies and rules.
View listings of Richman Injectables (high-cost, adult, childhood, etc.), Gene and Cell Therapy agents (including CAR-T), and Behavioral Health medications.
Review the DMHC regulations summary and a compliance overview.
Review regulations for Blue Shield of California providers
Review regulations for Blue Shield Promise Health Plan providers
Find requirements and drug list for claims and encounters for Promise Medi-Cal and Cal MediConnect members.
