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Blue Shield of California Provider Connection Homepage
Claims
Learn how to submit claims electronically, search our Claims Fee Schedule for Blue Shield allowances, find resources on provider appeals and adjustments, and learn more about submitting claims, rules for payment and claim status.
Claim tools | Manage electronic transactions | Facility and professional fee schedules | Claim issues & disputes | Policies & guidelines | Additional resources
Claim tools

Access our tools to check claims status and submit claims, and find mailing addresses, payment policies, fees and more.

To learn how to use our tools, review these materials:

How to prescreen claims with C3 (PDF, 540 KB)

Introduction to Clear Claim Connection (C3) (PDF, 816 KB)

Clean claims submission tips (PDF, 24 KB)

How to use SympliSend Portal (PDF, 1 MB)

How to submit claims
Learn about submitting claims to Blue Shield electronically.
Check claim status
Check on the status of a claim searching by member name, dates of service and more.
Claims-Routing Tool
Find out where to submit your claims.
Submit claims via Office Ally
Submit, correct and resubmit claims and manage payments online using Office Ally.
Clear Claim Connection (C3)
Use our simulation tool to prescreen claims, view claim auditing rules, payment policies, and more.
Submit via SympliSend
Upload first time paper claims with attachments and respond to itemization requests for claims in process.
Manage electronic transactions

Learn how to submit claims and receive payments using Electronic Data Interchange (EDI) for faster processing and payment.

How to get started with EDI

EDI, EFT and ERA frequently asked questions

 

Enroll in EDI
Enroll in EDI for your organization, either through a clearinghouse or directly with Blue Shield.
EDI Companion Guides
Access our companion guides for trading partners.
HIPAA 5010 and ICD10 implementation
Read about changes to HIPAA standard transactions and codes.
Encounters Resources
Learn about submission requirements, monthly performance summary reports and more.
Facility and professional fee schedules

Search the facility and professional fee schedules for Blue Shield of California providers and learn how we establish allowances.

Professional Fee Schedule search

About professional fee schedule
Learn how we establish allowances for professional services.
View facility fee schedules
Access outpatient facility fee schedules for ASCs and hospitals.
Claim issues & disputes

Submit provider disputes, check status, and view letters online. You can also submit by mail. Find what you need on the Claim issues & disputes page.

More about providers disputes:

View submitted disputes

Download dispute forms to submit by mail

FAQs about submitting disputes online

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Provider disputes for Blue Shield of California Health Plan
Get details on the dispute filing process, including how to submit online or by mail.

Provider disputes for Blue Shield of California Promise Health Plan
Get details on the dispute filing process, including how to submit by mail.

View submitted disputes
Search disputes you've submitted online and by mail. You can also check status and view letters.

File a dispute by mail
Download the form and get instructions on how to submit your dispute.

Refund requests
Learn about overpayment refund procedures for Blue Shield of California providers.

No Surprise Billing Act
Begin an open negotiation to dispute a claim covered by this act. This is typically for out-of-network providers.
Policies & guidelines

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.

Ancillary claims filing
Review claim submission requirements for Blue Shield of California labs, specialty pharmacy and DME providers.
NCCI edits - physicians and hospitals outpatient
Learn about clinical coding edits for physicians & outpatient hospitals.
Payment policies and rules
Read an overview of Blue Shield's payment processing policies and rules.
Medications
View a list of Richman Injectables (high-cost, adult, childhood, etc.), Gene and Cell Therapy agents (including CAR-T) and Behavioral Health medications.
Special guidelines for claim forms
Find helpful guidelines for CMS 1500 and UB-04 claim forms.
National Drug Code requirements for physician administered drugs
Find requirements and drug list for encounters for Blue Shield Promise members.
Additional resources

Take advantage of educational resources and find important claim contacts.

Claims & billing tutorials
Find recorded webinars, eLearning, FAQs and "how to" guides.
Claims contacts
See phone numbers, addresses, and more.

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