News and announcements

Preferred Specialty Drug List for Medical Benefits Updated on January 1, 2024

December 31, 2023 - View a summary of the updated Preferred Specialty Drug List for medical benefits, effective January 1, 2024.
View list (PDF, 60 KB)

Specialists and facilities: Please share reports promptly with PCPs

December 1, 2023 - All specialty providers and facility administrators should promptly deliver consultation reports and facility discharge reports to their patients’ primary care provider (PCP) to support coordination of care.
Review notice (PDF, 93 KB)

New online dispute functionality

November 17, 2023 - You can now file disputes online for Blue Shield Medicare and Blue Shield Promise Medi-Cal claims. We’ve also revised the process for submitting bulk disputes. We now ask you to organize bulk dispute submissions by plan type – such as commercial, Medicare, or Medi-Cal.
See what's new

Medication Policy and Formulary Updates 4th Quarter 2023

November 2, 2023 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 1.2 MB)

ASPN Pharmacies Triage Services Available for Home Infusion, Beginning October 1, 2023

October 12, 2023 - Blue Shield of California has teamed up with ASPN Pharmacies (ASPN) to offer enhanced services and simpler processes for eligible HMO and PPO commercial plan members to arrange for home infusion services. Providers may now place orders with ASPN and they will work directly with members to find access to local home infusion providers.
Read frequently asked questions (PDF, 157 KB)

Cultural awareness and linguistics resources available

October 6, 2023 - Blue Shield has developed cultural awareness and linguistics reference materials to help our providers give the highest level of quality care and services to our shared members. These resources include free cultural competency training with CEU credits, demographics and language services information, translation services, and translated materials.
Access resources (PDF, 881 KB)

Provider Directory enhancement: Indicate that a provider offers gender affirming care

September 19, 2023 - We have recently updated the Blue Shield of California provider directory to enable you to indicate if a provider or organization offers gender affirming care services. This will allow members to use the Find a Doctor tool to connect with providers who offer these services. Please note that this identification should only be used for providers of specific gender affirming care services.
Read about the enhancement (PDF, 195 KB)

COVID 19 benefits policy

September 12, 2023 - Blue Shield of California has published a benefits policy regarding COVID-19 testing, therapeutics and related services, effective September 27, 2023, in accordance with California Health and Safety Code sections 1342.2 and 1342.3.
Review this COVID-19 benefit policy (PDF, 1.2 MB)

Medication Policy and Formulary Updates 3rd Quarter 2023

August 8, 2023 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 1.2 MB)

New forms available for radiation oncology prior authorization and post-service requests

June 30, 2023 - To help simplify the process of requesting authorization for radiation oncology services, Blue Shield of California has created two forms that may be faxed to us. One form may be used to request prior authorization and the other form may be used for post-service claims. Please note that use of these forms is NOT mandatory. We provide them to make it easier for you to submit requests and to help make sure that we receive all the information and documentation that is required to process claims.
See how to access the forms (PDF, 180 KB)

Medication Policy and Formulary Updates 2nd Quarter 2023

May 4, 2023 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 1.4 MB)

Preferred Specialty Drug List for Medical Benefits Updated on March 1, 2023

April 10, 2023 - View a summary of the updated Preferred Specialty Drug List for medical benefits, effective March 1, 2023.
View list (PDF, 29 KB)

How Senate Bill 1419 affects access to patient records and the sharing of test results

April 7, 2023 - Read a summary of California Senate Bill 1419 requirements for managing access to patient records and sharing test results. While some items in the bill are already part of existing privacy mandates, others may require changes to your current practices.
Read the summary (PDF, 248 KB)

ASPN Pharmacies Added to Blue Shield of California’s Drop Ship Program, April 1, 2023

April 4, 2023 - We are pleased to announce that on April 1, 2023, ASPN Pharmacies joined the Blue Shield of California Drop Ship Program. ASPN Pharmacies improves the provider experience in drug procurement by triaging and coordinating prescription fulfillment, with status updates available through the ASPN web portal.
Read frequently asked questions (PDF, 83 KB)

Genetics Medical Policy Updates

March 9, 2023 - Blue Shield of California recently notified providers that we are working to clarify and simplify coverage of genetic tests. In the coming months we will be reorganizing, updating, and reformatting our genetic testing medical policies and making those policies easier to locate. We will continue to post updated versions of these policies throughout 2023. You can review genetic testing medical policies on our Provider Connection website www.blueshieldca.com/provider.
Review notice (PDF, 44 KB)

Home Infusion Benefit Change Lowers Cost for Eligible Medication Infusion Therapy Services for Blue Shield commercial PPO plan members

February 10, 2023 - Blue Shield of California is supporting its mission to lower the cost of health care for members by improving home infusion benefits for commercial PPO plan members. Members with prescriptions for medication infusion therapy services in an outpatient hospital setting can receive their infusion at their home from a network home infusion provider at a $45 copay.
Read frequently asked questions (PDF, 82 KB)

Medication Policy and Formulary Updates 1st Quarter 2023

February 2, 2023 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 926 KB)

Specialists and facilities: Please share reports promptly with PCPs

December 21, 2022 - Coordination of care in the primary care practice involves organizing patient care activities and sharing information among all the participants serving the patient. Timely communication is essential to the effectiveness, safety, and efficiency of our healthcare system. All specialty providers and facility administrators should promptly send consultation reports and facility discharge reports to their patients’ primary care provider (PCP) to support coordination of care. Increased communication between specialists, administrators, and PCPs will help improve our quality of care and patient satisfaction.

Update to Genetic and Molecular Testing Payment Policy effective January 1, 2023

December 6, 2022 - Blue Shield of California recently notified providers that it will issue an update to the existing Genetic and Molecular Testing Payment Policy. The update will require that all providers include a Genetic Testing Unit (GTU), along with the genetic and molecular testing service procedure code, when submitting claims for genetic and molecular testing. A copy of the Genetic and Molecular Testing Payment Policy is available to view or download from our Provider Connection Website, www.blueshieldca.com/provider.
Review notice (PDF, 126 KB)

Now submit claim disputes online

December 2, 2022 - We are pleased to announce a new way to file provider disputes. You now have the option to submit disputes involving your commercial, Shared Advantage® and BlueCard® claims online, in addition to using the existing mail-in process.
Learn more

Plan Closures and Transitions to Medicare Advantage HMO and D-SNP Plans,  January 1, 2023

November 15, 2022 - The Blue Shield Coordinated Choice (HMO) plan and all Blue Shield Promise Cal MediConnect (CMC) plans end December 31, 2022. On January 1, 2023, those members will automatically transition into an existing Blue Shield Medicare Advantage Prescription Drug Plan or, in Los Angeles and San Diego Counties only, into a Dual Eligible Special Needs Plan (D-SNP). The presentation below explains these plan closures and transitions.
Access 2023 plan closures and transitions presentation (PDF, 3 MB)

Plan Closures and Transitions to Medicare Advantage HMO and D-SNP Plans,  January 1, 2023

November 15, 2022 - The FAQ below answers questions related to plan closures and transitions, plus provides general information about D-SNPs. The Blue Shield Coordinated Choice (HMO) plan and all Blue Shield Promise Cal MediConnect (CMC) plans end December 31, 2022. On January 1, 2023, those members will automatically transition into an existing Blue Shield Medicare Advantage Prescription Drug Plan or, in Los Angeles and San Diego Counties only, into a Dual Eligible Special Needs Plan (D-SNP).
View frequently asked questions (PDF, 1 MB)

2023 Blue Shield Tandem PPO Network Resource Guide

November 15, 2022 - Blue Shield’s Tandem PPO Network and Full PPO Network are different. This guide explains how to determine if you are contracted for participation in the Tandem PPO Network. If yes, the tools and tips contained within this guide will help you identify Tandem PPO plan members, whether your practice location can provide in-network services, and how to file claims to be accurately reimbursed.
Access the 2023 Tandem PPO Network guide (PDF, 2 MB)

Medication Policy and Formulary Updates 4th Quarter 2022

November 3, 2022 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 1.1 MB)

Easily update and attest provider directory information online

September 16, 2022 - We recently made changes to the Provider Connection website that enable you to easily attest to the accuracy of your organization’s provider directory information online and update your data when needed. These changes will make it simpler to comply with federal and state mandates, including the 2021 Consolidated Appropriations Act (CAA).
Read frequently asked questions (PDF, 1 MB)

Cultural awareness and linguistics resources available

September 12, 2022 - Blue Shield has developed cultural awareness and linguistics reference materials to help our providers give the highest level of quality care and services to our shared members. These resources include free cultural competency training with CEU credits, demographics and language services information, translation services, and translated materials.
Access resources (PDF, 881 KB)

Virtual National Hypertension Control Roundtable – September 15-16

September 9, 2022 - You are invited to the upcoming virtual Act for Equity Summit for the National Hypertension Control Roundtable (NHCR) on September 15 and 16, 2022. The two-day online, interactive summit will explore hypertension and public health—the latest science, understanding disparate impacts for women and people of color, and systems-level solutions to address hypertension control.
Read more about the summit (PDF, 145 KB)

OIG Special Fraud Alert: Arrangements with purported telemedicine companies

September 2, 2022 - On July 20, 2022, the Office of the Inspector General (OIG) issued “Special Fraud Alert: OIG Alerts Practitioners to Exercise Caution When Entering into Arrangements with Purported Telemedicine Companies.” For your convenience, we have created a summary of the alert.
View summary (PDF, 404 KB)

Site of Service Program Policy Drug List Update

September 1, 2022 - View Site of Service Program drug list update.
View drug list (PDF, 29 KB)

Medication Policy and Formulary Updates 3rd Quarter 2022

August 4, 2022 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 192 KB)

Enhancements to member rosters on Provider Connection

July 27, 2022 - During the past few months we have made several enhancements to the member rosters functionality on the Provider Connection website, including monthly alert emails, labels highlighting updates, disenrollment dates, and redetermination dates.
Learn about enhancements (PDF, 249 KB)

Preparing for provider directory updates mandated by the 2021 Consolidated Appropriations Act

June 3, 2022 - In the next few weeks, Blue Shield of California will release changes to its Provider Connection website to support the 2021 Consolidated Appropriations Act (CAA) provider directory requirements that took effect on January 1, 2022. We invite our network participants to prepare by registering for Provider Connection and learning more about what actions will be required.
Read frequently asked questions (PDF, 112 KB)

New: Maven Maternity provides virtual support for eligible members throughout their pregnancy journey

May 26, 2022 - We are pleased to launch Maven Maternity, a new, innovative maternity program available to eligible Blue Shield of California (Blue Shield) HMO and PPO commercial plan members. Blue Shield is partnering with Maven to bring a wide range of support services to expectant mothers and their partners. Learn more at www.blueshieldca.com/maternity.
We encourage you to share this flyer with eligible patients (PDF, 377 KB)

Medication Policy and Formulary Updates 2nd Quarter 2022

May 5, 2022 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 227 KB)

Specialty Preferred Drug List for Medical Benefit Update

April 1, 2022 - View a summary of the Specialty Preferred Drug List for Medical Benefit update.
View summary (PDF, 33 KB)

Changes to preferred drugs and reimbursement rates, effective April 1, 2022

April 1, 2022 - Beginning today, Inflectra and Avsola will be Blue Shield of California’s preferred infliximab products. Fulphila will become a preferred pegfilgrastim product and Udenyca will move to a non-preferred status. Additionally, the reimbursement rate for infliximab, bevacizumab, trastuzumab, and rituximab biosimilar preferred alternatives will increase for Blue Shield PPO commercial plan members.
Read FAQ (PDF, 101 KB)

Claims pages updated on Provider Connection

February 15, 2022 - Blue Shield of California Provider Connection claim pages now have an updated, streamlined layout with more helpful information all in one place.
Learn about updates (PDF, 102 KB)

Medication Policy and Formulary Updates 1st Quarter 2022

February 6, 2022 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 164 KB)

Changes to Provider Connection for BlueCard claims

January 25, 2022 - Now it’s easier for providers to access information for patients insured by Blue plans in other states. Providers can view available letters related to a BlueCard claim and request status, eligibility, and benefits information directly from the claims page.
View more details (PDF, 81 KB)

Preparing for provider directory updates mandated by the 2021 Consolidated Appropriations Act

November 16, 2021 - Blue Shield of California is preparing to support the 2021 Consolidated Appropriations Act (CAA) provider directory requirements that will take effect on January 1, 2022. We invite our network participants to prepare as well, by registering for Provider Connection and learning more about what actions will be required.
Read frequently asked questions (PDF, 1 MB)

Medication Policy and Formulary Updates 4th Quarter 2021

November 4, 2021 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 179 KB)

Recent enhancements to Provider Connection Claims section

October 12, 2021 - We’ve updated the Claims pages on the Provider Connection website to make it easier to find claims and view more of them at once. Log in and visit the Check claims status landing page to take a tour!
Go to Check claim status

New extended hours for Provider Information & Enrollment – 6 a.m. to 6:30 p.m.

October 4, 2021 - The Blue Shield of California Provider Information & Enrollment team is now available to assist you between the hours of 6 a.m. and 6:30 p.m., Monday through Friday, at (800) 258-3091. After hours and during the weekend, our automated system will receive your calls and offer guidance. Please do not hesitate to reach out if you need assistance.

New Visits Accumulator functionality

September 27, 2021 - The Visits Accumulator, found in the Eligibility & benefits section of Provider Connection, tracks a member’s visits to specialty providers when their plan covers a set number of visits per plan year. The Visits Accumulator tracks chiropractor, acupuncture, occupational therapy (OT), physical therapy (PT), respiratory therapy (RT) and combined visits for the current plan year and the member’s most recent prior plan year. Note that the Visits Accumulator only tracks visits that are paid by Blue Shield. Specialty visits that are covered by third parties such as American Specialty Health (ASH), Medi-Cal, or Medicare will not be tracked by the Visits Accumulator.
Read the Reference Guide (PDF, 2476KB)

Use the new BlueCard address for claims sent to Blue Shield of California for services provided in California

August 24, 2021 - Earlier this year, we have assigned a new mailing address for receiving your BlueCard claims for services you provide within California to Blue Plan members. Please be certain to use the address below when sending BlueCard claims for services provided in California. New and current BlueCard claims mailing address: Blue Shield of California BlueCard Program P.O. Box 272630 Chico, CA 95927-2630 We want to provide you with accurate and timely service. Although some BlueCard claims sent to the former mailing address at Blue Shield have been forwarded to the new mailbox, we are hearing that some are NOT being forwarded due to “no forwarding” directives or other reasons. We strongly urge you to begin using the new address immediately to ensure your claims are received by Blue Shield as quickly as possible.

Medication Policy and Formulary Updates 3rd Quarter 2021

August 5, 2021 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 168 KB)

How to download members’ ID cards

June 11, 2021 - Blue Shield of California providers can easily download members’ ID cards to access the information they need, saving time and reducing environmental waste. We’ve posted a 1-page resource on Provider Connection to show you how. (Login required.)
See instructions (PDF, 40KB)

Medication Policy and Formulary Updates 2nd Quarter 2021

May 6, 2021 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 175 KB)

Provider Connection Enhancements

April 14, 2021 - We are pleased to announce the latest enhancements to the Provider Connection website! Changes include improved web page design in several areas, and the ability for Account Managers to use the Provider Demographics page to update the practice information that appears in the Find a Doctor tool. We also added two new features to the Real-Time Claims web tool: service line split (unbundling) and a self-referral option. Please check the revised Provider Connection Reference Guide for information about these enhancements.
View guide (PDF, 2.2 MB)

New extended hours for Provider Services – 6 a.m. to 6:30 p.m.

March 16, 2021 - The Blue Shield of California Provider Services team is now available to assist you between the hours of 6 a.m. and 6:30 p.m., Monday through Friday, at (800) 541-6652. After hours and during the weekend, our automated system will receive your calls and offer guidance. Please do not hesitate to reach out to Provider Services if you need assistance.

Real-Time Claims web tool enhancements

February 11, 2021 - The Real-Time Claims web tool, available on Provider Connection, has recently been updated to include: the ability to print estimates and claims; error messages; NPI search capability; copay field; dashboard manual refresh; and the ability to manually expire an estimate. Please refer to our Frequently Asked Questions document to learn more about the Real-Time Claims web tool.
View the PDF (PDF, 106 KB)

Medication Policy and Formulary Updates 1st Quarter 2021

February 4, 2021 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 146 KB)