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Blue Shield of California Blue Shield of California Provider Connection Homepage
  • Eligibility & benefits
    • Overview
    • Verify eligibility
    • Member rosters
    • Benefit summaries
    • Preventive health guidelines
    • HEDIS reporting
  • Authorizations
    • Overview
    • Medical authorization
    • Medical authorization status
    • Pharmacy authorization
    • Pharmacy authorization status
    • Out-of-area Blue plan members
    • Policies & guidelines
    • Authorization forms & list
  • Claims
    • Overview
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    • How to submit claims
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    • Check claim status
    • Manage electronic transactions
    • Fee schedule
    • Claim issues & disputesNEW
      New

      File disputes online

      You can now file disputes, attach supporting documents, and retrieve letters for submitted disputes online! Available for commercial, Shared Advantage®, and BlueCard®.

      Learn more
    • Policies & guidelines
  • Guidelines & resources
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  • Claims contacts

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, 6 a.m. to 6:30 p.m., Monday through Friday

 

  • 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)

     
    Blue Shield of California
           Attn: EDI Department
           4700 Bechelli Lane
           El Dorado Hills, CA 95762-9017
    Email:EDIPriority@blueshieldca.com

    EDI Help Desk:

      Phone:(800) 480-1221
    Email:EDI_BSC@blueshieldca.com

    EDI/ERA/EFT inquiries including Enrollment questions:

    Phone:(800) 480-1221

    Fax EDI enrollment forms to:

    Fax: (530) 351-6150

    Fax ERA/EFT Enrollment forms to:

    Fax: (866) 276-8456

  • 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 Medicare members

     Appeal process
    Grievance process

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

     Appeal and grievance process

    Appeals and grievance process for Blue Shield Promise Cal MediConnect members

     Appeal process
    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) 622-0632, 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

General contacts

Find phone and fax numbers for Blue Shield corporate offices, provider and pharmacy services, medical management, EDI program and technical services.

Get contact information

Eligibility and benefits contacts

Find phone and fax numbers for Blue Shield eligibility and benefits contacts.

Get contact information

Authorization contacts

Contact Medical Care Solutions for questions about authorization requests, preauthorization, medical policy, and more.

Get authorizations contact information

Guidelines and resources contacts

Find phone and fax numbers for compliance and ethics,  disease management, wellness prevention, and more.

Get contact information

Technical support request form

Request help with your log in, registration or other technical problems.

Request tech support

Provider Connection Reference Guide

Find detailed instructions for activities like checking eligibility, making a referral, determining if prior authorization is necessary, prescreening claims, checking claims status, and other tools and information you need to serve our members.

View reference guide for Blue Shield providers (PDF, 2.7 MB)

View reference guide for Blue Shield Promise providers (PDF, 2.5 MB)

About Provider Connection

Learn about the range of information and tools available to Blue Shield of California providers on this website.

Learn more about Provider Connection

Company holidays

Operation centers will be closed in observance of Blue Shield of California’s holiday schedule, with the exception of Medicare Member Services.

View holiday schedule

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