Guidelines and resources contacts

Compliance & Ethics

Call to report Code of Conduct, compliance or ethics issues.
Helpline: (888) 800-2062
Hotline: (855) 296-9083

        Online Reporting: Compliance & Ethics Web Hotline

        Email: corporate-compliance@blueshieldca.com

Special Investigations Unit

Call to report fraud-related issues.
Helpline: (800) 221-2367
Hotline: (855) 296-9092

        Online Reporting: Special Investigations Web Hotline

        Email: stopfraud@blueshieldca.com

Privacy

Call to report privacy or confidentiality issues (mishandling or unauthorized disclosure of IIPI or PHI).
Helpline: (888) 266-8080
Hotline: (855) 296-9086

        Online Reporting: Privacy Web Hotline

        Email: privacy@blueshieldca.com

Medicare Compliance

Call to report Medicare-related legal or compliance issues.
Helpline: (800) 445-2517
Hotline: (855) 296-9084

        Online Reporting: Medicare Compliance Web Hotline

        Email: Medicare.Compliance@blueshieldca.com

Call for information on preventive health, wellness, and disease management programs.

Disease management referrals for Blue Shield of California members

To obtain a copy of the referral form, email Blue Shield of California:
Email:center.hw@blueshieldca.com

Submit a referral form using secure email or fax:
Email: bscliaison@alere.com
Fax: (877) 280-0179

Population Health Management program for Blue Shield Promise members

Phone: (800) 468-9935, 8 a.m. to 5 p.m., Monday through Friday

LifeReferrals 24/7^SM

(doesn't apply to Blue Shield 65 Plus)
Phone;(800) 985-2405

Case management referrals for Blue Shield of California members

Using secure email, submit patient name, member ID number, and reason for referral:
Email:edhccmr@blueshieldca.com
Phone:(877) 455-6777

Complex Case Management referrals for Blue Shield Promise members

  Provider Services:(800) 468-9935
Fax: (323) 889-6575

NurseHelp 24/7^SM for Blue Shield of California members

Blue Shield of California
      Center for Health & Wellness
      P.O. Box 7168
      San Francisco, CA 94120-7168

Phone:(877) 304-0504
Email: center.hw@blueshieldca.com

24/7 Nurse Advice Line for Blue Shield Promise members

Phone:(800) 609-4166 [TYY: 711]

Blue Shield Promise Transitional Care Management program

Phone:(877) 702-5566, 8 a.m. to 6 p.m., Monday through Friday

Behavioral Health Services for Blue Shield Promise members

Find information and contacts

HMO and PPO

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

Members should call the first 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, TTY 711

Standard and expedited appeal fax: (916) 350-6510

Blue Shield of California Promise Health Plan
Member Services
601 Potrero Grande Dr.
Monterey Park, CA 91755

Blue Shield Promise Medicare

Contact us 8 a.m. - 8 p.m., seven days a week from October 1 through March 31, and Monday through Friday from April 1 through September 30:
Phone: (800) 544-0088 [TTY: 711]
Fax: (866) 712-2731
Send us an email

Blue Shield Promise Medi-Cal

 Send us an email
Find contact information by service area

Blue Shield Promise Cal MediConnect

Contact us 8 a.m. - 8 p.m., seven days a week:
Phone: (855) 905-3825 [TTY: 711]
Fax: (323) 889-5416
Send us an email

Contact us for drug formulary information and to request prior authorization for outpatient prescription drugs and home self-administered injectables.

For Blue Shield providers

Blue Shield of California
      Pharmacy Services
      P.O. Box 7168 
      San Francisco, CA 94120-7168

Phone:(800) 535-9481

Fax: (888) 697-8122

For Blue Shield Promise providers

Phone:(800) 468-9935

Call for questions about:

• Member eligibility
• Blue Shield Express Line
• Claims/billing questions
• Plan benefits
• Billing address/forms
• Assistance with language other than English
• Locating network providers-provider directories

HMO and PPO:

Blue Shield of California
Customer Services
P.O. Box 272540
Chico, CA 95927
Phone: (800) 541-6652, Monday - Friday, 8 a.m. – 5 p.m.

Blue Shield 65 Plus (HMO):

Blue Shield of California&
P.O. Box 272640
Chico, CA 95927-2640
Phone: (800) 541-6652, TTY 711, Monday – Friday, 8 a.m. – 5 p.m.
Fax: (818) 228-5137 or (818) 228-5130

Call for questions about:

• Member eligibility
• Plan benefits
• Claims/billing questions
• Member authorizations

Blue Shield of California Promise Health Plan
601 Potrero Grande Drive,
Monterey Park, CA 91755-7430

Phone: (800) 468-9935 [TTY 711], 8 a.m. to 5 p.m., Monday through Friday

Contact us with questions about:

• Provider network inquiries and applications
• Address, phone, fax, and practice changes
• Group additions/deletions
• Credentials
• Provider directory updates
• Provider education
• Contractual obligations
• PPO related requests

Blue Shield of California
       Provider Information & Enrollment
       P.O. Box 629017
       El Dorado Hills, CA 95762

Phone:(800) 258-3091

Fax: (916) 350-8860, Monday - Friday, 6:00 a.m. - 6:30 p.m.

If you are an Ancillary provider who is interested in joining our network, you can submit a Letter of Interest by the following methods:

By email: PromiseLOI@blueshieldca.com

By mail: Blue Shield of California Promise Health Plan
       Attention: Provider Contracting
       601 Potrero Grande Dr.
       Monterey Park, CA 91755

Phone:(888) 398-2250

Email:BSC_Credentialing@blueshieldca.com

For technical issues with the Provider Connection website including password resets and problems logging in, please contact our Provider Services support desk.

Phone:(800) 541-6652

Online form:Technical support request

BlueCard provider customer services:

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

BlueCard resources

BlueCard program information

Policies and authorizations for out-of-state members

Claims routing tool

Federal Employee Program customer services:

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