Claims contacts

Blue Shield of California Provider Services:

 Phone: (800) 541-6652, 24 hours a day, seven days a week

Blue Shield of California Promise Health Plan Provider Services:

 Phone: (800) 468-9935, Monday through Friday, 6 a.m. to 6:30 p.m.
 

Claims

 See claims phone numbers and mailing addresses
 

Electronic Data Interchange (EDI) Department

Use of this technology can help speed receipt of payments, reduce paperwork, and improve accuracy when you submit claims, verify eligibility, obtain claim status, receive remittance advice, and receive funds transfer.

Contact us for questions about:

• EDI set-up inquiries (270/271, 276/277, 278, 837, 835)
• ERA set-up inquiries
• EFT set-up inquiries
• Member Benefit Enrollment set-up inquiries (820/834)

Call the EDI Help Desk at  (800) 480-1221
 

Blue Shield of California member appeals and grievances

HMO and PPO:

  Blue Shield of California 
       Appeals and Grievances
       P.O. Box 5588
       El Dorado Hills, CA 95762-0011

  Members should call the number on the back of their member ID card for appeals inquiries.
 

Blue Shield 65 Plus (HMO):

   Blue Shield of California
        Grievance Resolution Department
        6300 Canoga Avenue
        Woodland Hills, CA 91367-2555

  Medicare Member Services, phone: (800) 776-4466
  Hearing Impaired, phone: (800) 794-1099
 Standard and expedited appeal fax: (916) 350-6510
 

Blue Shield of California provider appeals

Dedicated Provider appeals line:

 Phone:(800) 541-6652

HMO and PPO:

 Blue Shield of California Initial Appeal Resolution Office
       P.O. Box 272620
       Chico, CA 95927-2620

 Blue Shield Initial Appeal Resolution Office
       Attn: Hospital Exception and Transplant Team
       P.O. Box 629010
       El Dorado Hills, CA 95762-9010

 Blue Shield Final Appeal Resolution Office
      P.O. Box 629011
      El Dorado Hills, CA 95762-9011
 

Blue Shield 65 Plus (HMO):

 Blue Shield 65 Plus
      Medicare Provider Appeals Department
      P.O. Box 272640
      Chico, CA 95927-2640
 Fax: (855) 895-3501
 

Blue Shield Promise member appeals and grievances

Appeals and grievance process for Blue Shield Promise Medi-Cal members

 Appeal and grievance process

Blue Shield Promise provider dispute resolution

Find dispute resolution policies, procedures and contact information for Blue Shield Promise providers:

 Policies, procedures and contacts for Blue Shield Promise Medicare providers

 Policies, procedures and contacts for Blue Shield Promise Medi-Cal providers

 Policies, procedures and contacts for Blue Shield Promise Cal MediConnect providers

Overpayments

If you find an overpayment, notify Blue Shield by contacting the appropriate service center.

If the overpayment involves a Coordination of Benefits (COB) issue, and Blue Shield processed the claim as the primary payer in error, please send a copy of the Explanation of Benefits (EOB) from the primary payer to the appropriate service center.

Blue Shield will research the claim and advise you of the amount of overpayment.

Overpayments from Blue Shield are to be directly refunded to Blue Shield. When requested, send refund checks to the following address:

  Blue Shield of California 
       Attn: Cash Receiving
       P.O. Box 241012
       Lodi, CA 95241
 

Other Blue plan members information

BlueCard provider customer services:

 (800) 676-2583, 6 a.m. to 9 p.m., Monday through Friday
 

BlueCard resources

 BlueCard program information

  Verify BlueCard member's eligibility

  Claims routing tool

Federal Employee Program members information

Federal Employee Program customer services:

  (800) 824-8839, 8:30 a.m. to 4:30 p.m., Monday through Friday