Guidelines and procedures
Find operating guidelines for clinical practices, hospitals, health assessment, preventive health, medical fraud prevention guidelines and find resources for providers continuing participation in Blue Shield of California network.
Preventive health guidelines
Access preventive health guidelines for healthy children, adolescents and adults. Included are immunizations, health screenings and more.
Clinical practice guidelines
Find recommendations for evaluating common acute and chronic conditions.
Utilization management procedures
Learn how Blue Shield makes utilization management decisions.
Learn more about procedures for Blue Shield of California providers
Review utilization management guidelines for Blue Shield of California Promise Health Plan providers
Resources for providers continuing participation in Blue Shield network
Find out how to continue participation in our network, including a recredentialing application and mailing instructions.
National Provider Identifier (NPI)
Learn about the National Provider Identifier, the unique number assigned to all healthcare providers to facilitate transactions.
Claims policies and guidelines
Learn about claims submission guidelines and time frames, rules for payment, and more.
Fraud prevention guidelines for Blue Shield Promise providers
Learn how to report suspected healthcare fraud and find prevention tips and guidelines.
Health assessment guidelines for Blue Shield Promise Medi-Cal providers
Learn how to conduct an assessment, find patient questionnaires, forms and training materials.