- Claims
-
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 95762-0011Members 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 91367-2555Medicare 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 95927-2620Blue Shield Initial Appeal Resolution Office
Attn: Hospital Exception and Transplant Team
P.O. Box 629010
El Dorado Hills, CA 95762-9010Blue Shield Final Appeal Resolution Office
P.O. Box 629011
El Dorado Hills, CA 95762-9011Blue 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 Medicare members
Appeal process
Grievance processAppeals and grievance process for Blue Shield Promise Medi-Cal members
Appeals and grievance process for Blue Shield Promise Cal MediConnect members
-
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) 622-0632, 6 a.m. to 9 p.m., Monday through Friday
BlueCard resources
-
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
