November 17, 2023
You can now use Provider Connection to file disputes online for Blue Shield Medicare and Blue Shield Promise Medi-Cal claims.
This continues our expansion of the ability to submit disputes online, which was first available for commercial, Shared Advantage® and BlueCard® claims last year and then included Federal Employee Program claims in September.
Although most Blue Shield of California and Blue Shield of California Promise Health Plan disputes can be submitted online now, you still have the option to submit them by postal mail. However, submitting disputes online is usually faster and more convenient.
New on December 14 – Dispute pages
- Submitted disputes pages: You can now search and filter disputes in one place, regardless of how they were submitted. This includes disputes submitted individually online, online as a bulk dispute, or by postal mail. Disputes submitted online will appear on Provider Connection right away, but disputes submitted by postal mail will take longer. The page’s performance has also been improved.
- Individual dispute pages (new): On the Submitted disputes page, each dispute is now linked to a separate page with detailed status information, letters, and submission documents. Before a dispute enters review, you can also attach supporting documents from this page.
Log in and visit the Submitted disputes page to see the new features.
Revised bulk dispute process
We now ask you to organize bulk dispute submissions by plan type – such as commercial, Medicare, or Medi-Cal. This makes it easier for us to route your requests to the correct Blue Shield or Blue Shield Promise department. The submission tool will help you identify plan types.
Bulk disputes must be for the same or similar issues. You can create bulk disputes in two ways:
- Enter claim numbers directly (up to 50): If your claims are from different plan types, you’ll be prompted to narrow your submission to one plan type. You can then submit additional bulk disputes as needed, for one plan type at a time.
- Upload a CSV file with a list of claims (up to 500): Similarly, if your claims are from different plan types, you’ll be prompted to sort them and upload separate lists, bundled by plan type. If you have more than 500 claims to dispute, you will also need to submit multiple bulk disputes.
How to submit a dispute
Aside from the changes noted above, the dispute submission process remains the same. You’ll need a claim number to get started. Once the claim number (or numbers, if bulk) is matched to a claim in our records, we’ll ask you to:
- Describe the issue, add the expected outcome, and attach supporting documentation for your case.
- Verify your contact information, including the email address where you want to receive notifications about the case.
- Review your submission, agree to receive electronic communications, sign, and submit it.
You’ll receive a confirmation with a case number right away. The dispute documents will be generated within 15 minutes after submission.
- A message will be sent to the email address you have provided when an acknowledgement, determination, or any other letter is ready to be viewed online.
- Your dispute letters, records, and status updates will be available on the corresponding dispute page.
If you’re a non-contracted provider, the Centers for Medicare and Medicaid Services (CMS) requires a waiver of liability to be signed by you when disputing a denied Medicare claim. These claims can’t be bundled and need to be disputed separately. You will be asked to waive the right to collect payment from the member.
View the Submit claim disputes online tutorial
Note:
Submitting disputes and claims correctly ensures that your documents are received by the appropriate Blue Shield or Blue Shield Promise department. The dispute process is reserved for requesting payment reconsideration for a claim (or claims) that have been denied, paid at less than billed charges, or otherwise contested. Learn more about the dispute process to ensure your issue qualifies.
If you have additional information to send for a submitted claim, please use the attach documents to a claim page on Provider Connection.
To upload claim documents or file disputes online:
- You must be registered on Provider Connection and have access to claims granted by your Account Manager.*
- Log in and find a claim. Then from the Claims page, select either the “Attach documents to a claim” or “Resolve claim issue or dispute” link in the header, depending on the task at hand.
Have a question?
Visit
- Frequently asked questions about provider disputes
- Provider Connection Help for step-by-step instructions on how to dispute a claim online, see the “Claims > Dispute a claim decision online” section.
You can always contact us if you need help.
*If no one in your organization is currently registered as an Account Manager on Provider Connection, please register now and set up user accounts for your team so you will be able to upload claim documents and file provider disputes online. Access to claims is required to perform these actions or view past records.