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Provider Connection help

Find help in creating a Provider Connection account, viewing authorization status, working with claims, receiving messages, and more.

Eligibility and benefits

  • Verifying eligibility and benefits for a single member

    Select the Search single member tab on the Verify eligibility page to determine eligibility and benefits for one Blue Shield of California/Promise Health Plan, other Blue plan, or Federal Employee Program member at a time.

    To search for a Blue Shield of California or Promise Health Plan member:

    1. Choose Blue Shield of California/Promise Health Plan as the member coverage / card type.
    2. Enter the subscriber ID (9-16 alphanumeric characters) OR the member’s last name, first name, and birth date. All fields are required.
    3. Select Search.

    NOTE: Blue Shield of California subscriber eligibility and benefit information is available for up to 24 months before today’s date and one year before a member’s termination. Eligibility information is updated daily.

    To search for other Blue plan or Federal Employee Program (FEP) members:

    1. Choose the member coverage / card type.
    2. Select the type of member. The subscriber is the primary member. A dependent is any family member covered by the subscriber’s plan.
    3. For subscriber, enter the subscriber ID (9-20 alphanumeric characters), last name, first name, birth date, gender, and eligibility/service date. For dependents, you must also enter the subscriber’s last name.
    4. Choose your National Provider Identifier (NPI) from the drop-down list. If your NPI is not listed, select NPI not listed and enter your NPI in the new field.
    5. Choose the service category and service type to request specific benefit information.
    6. Click Search.

    Tips:

    • All search fields are required.
    • You can identify an FEP member by the ID prefix R00 to R99.
    • Searching other Blue plan and FEP member eligibility involves multiple database queries and may take more time. Once the search is complete, results will be presented on the page and/or in the Message center.
    • Other Blue plan and FEP member information is provided by the member’s home plan. The home plan is responsible for the quality and availability of the information.
  • Snapshot of a single member’s eligibility

    When you conduct a search to verify a single member’s eligibility, the search results provide a snapshot of the member’s eligibility information. This information also appears in the member’s eligibility details.

    A Blue Shield of California member’s eligibility snapshot includes:

    • Member name
    • Subscriber ID
    • Eligibility status based on current medical coverage
    • Basic member information: birth date, gender, and residence address
    • Coverage information: plan name, plan type, coverage start and end date, relationship to subscriber, and subscriber name
    • PCP name
    • In-network office visit copay information
    • Links to member details, ID card, benefits, and claims

    A Promise Health Plan member’s eligibility snapshot includes:

    • Member name
    • Subscriber ID
    • Eligibility status based on current medical coverage
    • Basic member information: birth date, gender, and residence address
    • Coverage information: plan line of business (LOB), region, coverage effective date, redetermination date, and recipient information
    • PCP name and participating provider group information
    • Links to member details, ID card, benefits, and claims

    Note: If a member doesn’t have current coverage, future-plan information is displayed. If a member has neither current nor future coverage, the latest past plan information is displayed.

    Other Blue plan or Federal Employee Program member’s eligibility snapshot includes:

    • Member name
    • Subscriber ID
    • Eligibility status based on current medical coverage
    • Basic member information: birth date, gender, and residence address
    • Plan type, coverage period, and relationship to subscriber
    • Links to member details, benefits, and deductibles/out-of-pocket maximums information
  • Verifying eligibility and benefits for multiple Blue Shield of California and Promise Health Plan members

    You can search for eligibility and benefits information for up to 10 Blue Shield of California or Promise Health Plan members at a time. Select the Search multiple members tab on the Verify eligibility page.

    (Multiple search is not available for other Blue plan and FEP members.)

    To search for multiple members:

    1. Enter the subscriber IDs (9–16 alphanumeric characters) for up to 10 members. Examples:
      • XEA123456789,
      • J12345678,
      • 123456789
    2. Click Search.

    To delete subscriber ID entries individually, click on the eraser icon next to each field. Or you can click Clear form to clear all fields.

    Search results for multiple Blue Shield of California members include the member’s name, birth date, subscriber ID, relation to subscriber, and links to member eligibility details and claims. Benefit information is available from the details page.

    Search results for multiple Promise Health Plan members include the member’s name, birth date, subscriber ID, line of business (LOB), and links to member eligibility details and claims. Benefit information is available from the details page.

    Note: Blue Shield of California subscriber eligibility and benefit information is available for up to 24 months before today’s date and one year before a member’s termination. Eligibility information is updated daily.

  • Member eligibility details (Blue Shield of California and Promise Health Plan members)

    You can access Blue Shield of California and Promise Health Plan member eligibility details by clicking on the member’s name or the Details link in the search results for single or multiple members.

    Member eligibility details contain:

    • Member eligibility snapshot, including subscriber ID and eligibility status
    • Member information (phone number, preferred language, subscriber dues information for Blue Shield of California members or federal or state ID number and AID CD/Group information for Promise Health Plan members).
    • PCP and IPA/physician group details displaying current, future, and past PCP and physician group information (address, phone number, coverage period, and provider/group ID).
    • Coverage details displaying information for current, future, and past medical coverage for up to 24 months from current date. Coverage details for Blue Shield of California members include coverage effective period, plan name, group number, and employer name. Coverage details for Promise Health Plan members include coverage effective period, plan line of business (LOB), AID CD/group, and region.
    • Deductibles and out-of-pocket maximums are displayed for current, future, and past coverage.
  • Deductible and out-of-pocket maximum details

    The deductible and out-of-pocket maximum details show accumulative and current deductible and out-of-pocket information.

    The deductible amount is the initial amount members must pay in a calendar year (January 1 through December 31) for certain covered services before they become eligible to receive certain benefits.

    The out-of-pocket maximum amount is the total amount that a member has to pay in out-of-pocket expenses for covered services received during any calendar year of coverage.

  • Benefit details

    To see benefit information for Blue Shield of California and Promise Health Plan members, search for the member, then select the Benefits icon. Benefits information on Provider Connection is formatted to reflect the member’s Evidence of Coverage, but to make finding information easier, benefit categories and subcategories are listed alphabetically. You can search for a category or scroll down the list.

    Note: You may view current or historical benefits-coverage data by selecting a time period from the Coverage period drop-down.

  • Member rosters

    This page offers access to the most up-to-date roster of members who have chosen you as their primary care physician (PCP) or medical group.

    The roster can be filtered by performing a search based on practice or provider name.

    The expanded view presents a breakdown of the member roster by attribution status (active, new, disenrolled, redetermined). Click on the count under each status for a detailed member list that can be downloaded and saved to your computer.

Claims

  • Searching claims

    Providers can search for claims submitted for Blue Shield of California, Promise Health Plan, other Blue plan (including BlueCard), and Federal Employee Program (FEP) members.

    The claims search is set to search all plans by default.

    You can also choose to search only other Blue plans or by appeal status.

    Search all plans

    • Only 1 field is required when searching all plans. Because a 2-year date range is set by default, you can leave all fields blank and simply click on Search. Then you’ll see all claims from the last 2 years.
    • Narrow your search by changing the date range, filling in additional fields, and checking boxes to search based on claim status.
    • To search by amount paid or amount billed, first select Search, then filter the results by amount paid or billed. You can also filter results by provider, claim status date, patient’s responsibility amount, or claim type (medical or dental).
    • A search only displays 1,000 results. If more than 1,000 results are found, to see all results, select Export, and a spreadsheet will download. (You can also download a spreadsheet for fewer than 1,000 results.)
    • To find other Blue plan (BlueCard) claims submitted to Blue Shield of California, search All plans. For all other BlueCard claims, search Other Blue plan claims.

    Search other Blue plan member claims

    All fields are required to search for other Blue plan claims. Results will be sent to your Message center within 72 hours.

    Search by appeal status

    Search by number of the original claim or CS task to see whether an appeal is open or closed. For details, call the provider appeals line at (800) 541-6652.

    Search results/details

    • Each search result has 4 elements to click on for more details: claim #, member name, EOB report, and check/EFT information.
    • Select claim # to see claim details, including service details and claim notes. Payment decisions are explained here in the claim notes (you can also find them on the EOB).
    • Click on Check/EFT number to see information about all claims paid by that transaction.

    Downloading EOBs

    You can access EOBs in 2 places: on the search results page and a level deeper on the claim details page. EOBs list all the claims paid by one transaction. Payment decisions are explained here (you can also find them in the claim notes section of the claim details page).

    Claim-activity dashboard

    At the top of the Check claim status page, this dashboard displays all claims with status changes in the last 24 hours. You can collapse this section if you prefer.

    My pinned claims

    Just below the claim-activity dashboard, this section allows you to track up to 9 claims at a time. You can collapse this section if you prefer.

  • Downloading EOBs

    To locate an EOB, go to the Check claim status page and conduct a search.

    Then you can access EOBs in 2 places: on the search results page and a level deeper on the claim details page. EOBs list all the claims paid by one transaction. Payment decisions are explained here, too.

  • Finding EOBs by amount paid or amount billed

    To locate an EOB by amount, first go to the Check claim status page. Under Search claims activity, select Search without filling out any fields. Then on the search results page, use the filters on the left to find a claim by specific amount or amount range. You can download the EOB once the claim is found.

  • Finding claims by check or EFT number

    To find a claim by check or EFT number, go to the Check claim status page. Under Search claims activity, enter the payment number in the Claim, EOB, or check/EFT number field and select Search.

  • Claims-routing tool

    To find out where you should send a BlueCard claim, enter the 3-character prefix and the date of service into the Claims-routing tool.

    The 3-character prefix precedes a Blue Cross or Blue Shield member’s identification number. This prefix identifies the member’s home plan and where to address claims.

    The date of service is the month, day, and year a Blue Cross or Blue Shield member received medical services from the provider.

  • Prescreen claims with Clear Claim Connection (C3)

    Clear Claim Connection (C3) is a simulation tool that gives providers a view into the claim-auditing rules, payment policies, and clinical rationales of Blue Shield of California’s claims processing. C3 does not submit claims to Blue Shield and is not a guarantee of member eligibility or claim payment. It is a tool used to test codes on mock claims and reference their rationales from nationally recognized sources.

    Providers can enter CPT and HCPCS coding scenarios and immediately view the audit result. By prescreening claims, you will minimize your administrative costs and simplify doing business with us.

Authorizations

Managing your Provider Connection account

  • Creating a Provider Connection user account

    Only Provider Connection account managers can create accounts for their users. Ask your account manager to create a Provider Connection account for you.

    Not sure whether you should be a user or an account manager? Here’s what each can do.

      User Account manager
    View claims information
    Submit and view authorizations
    View member eligibility information
    Create user accounts  
    Manage access to TINs  
    Grant access to claims and other information  
    Reset Provider Connection user account passwords  
    Disable, reactivate, or delete user accounts  
    Approve billing manager access to TINs  

    Account managers must register for their own accounts. Then they can create user accounts at Account management > Manage user accounts.

  • Logging in

    You must log in to access the secure tools and content on Provider Connection. To log in, you have to have an account created by your organization’s Provider Connection account manager. You will need your username and password to log in.

    To log in:

    • Enter your username in the username field.
    • Enter your password in the password field.
    • Select Log in.
  • Managing your profile

    To update your account profile or change your password, go to Manage my profile.

    You can update your name, address, phone number, username, email address, and email preferences here.

    Before you can make some changes, we email you a security code. This allows us to validate your identity and protect our members’ privacy.

    Note: Have opinions and ideas about how we can improve Provider Connection? Be sure to join our website user group and check the box next to Occasional surveys, both on Manage my profile.

  • Changing your password

    You must change your Provider Connection password:

    • The first time you log in
    • Every 90 days
    • Anytime your password has been reset by an account manager or customer service

    If your password has expired, we’ll direct you to change it.

    To change your password:

    1. On Manage my profile, select Edit on the Password tile.
    2. Select Request code, and we’ll email you a security code.
    3. Enter the security code and select Continue.
    4. Enter your current password, a new password (twice), and select Save.

    If your account has been deactivated, contact your account manager. You can also fill out a Technical support form or contact us.

  • If you forgot your username or password

    If you can’t remember your username, get help at Forgot your username? Enter your full name and email address, and we’ll email your username to the email on file for your account.

    Pro tip: If you’re not sure which email address was used to create your account or your email has changed, check your email address at Manage my profile. You can update it there first, then have your username emailed to the new address.

    If you forgot your password, get help at Forgot your password? Enter your username, and we’ll email a security code to the email on file for your account. Then you can change your password.

    Pro tip: If your account doesn’t have an email on file, we don’t recognize your username, or you haven’t yet verified your email after your account was created, we won’t be able to email you a security code. In those cases, you need to contact us for help.

  • Using your Message center

    The Message center is where you receive messages about eligibility, benefits, and claims search results you’ve requested for other Blue plan and Federal Employee Program (FEP) members. Each user account has its own Message center—only you can see your messages.

    You can access your Message Center from any page in Provider Connection by clicking the link in the top navigation.

    Unread messages appear in bold. Once you've opened a message it will no longer appear in bold. You may mark a viewed message as unread by selecting its check box and then clicking the "Mark as Unread" icon at the top of the message list.

    Read messages are deleted after 45 days. To manually delete any message, check its checkbox in the list of messages, then click Delete. Once you delete a message, it is permanently removed from the system and cannot be retrieved.

    Other Blue plan and FEP members' eligibility and claims search results that cannot be retrieved within 45 seconds are automatically sent to your Message center when the search results are ready.

For account managers

  • Create a new user account

    Create user accounts for people in your organization who need access to the information associated with tax ID numbers (TINs). All users can view eligibility and authorization information. As the account manager, you can also grant them access to claims and real-time claims.

    To create a user account, go to Account management > Manage user accounts. Enter the person’s name and email address and assign them at least one TIN. You may choose to grant them access to claims information. If you do, you can also grant access to real-time claims information.

    What happens next: We’ll email them a temporary password right away. They have 30 days to visit the site and change their password or the account will be deleted. We’ll notify you 7 days before the account is deleted and again if it is deleted.

    Not sure whether you should be a user or an account manager? Here’s what each can do.

      User Account manager
    View claims information
    Submit and view authorizations
    View member eligibility information
    Create user accounts  
    Manage access to TINs  
    Grant access to claims and other information  
    Reset Provider Connection user account passwords  
    Disable, reactivate, or delete user accounts  
    Approve billing manager access to TINs  

    Account managers must register for their own accounts. Then they can create user accounts at Account management > Manage user accounts.

  • Reset a user’s password to unlock their account

    If a user becomes locked out of their account, reset their password to unlock it.

    To do this, go to Account management > Manage user accounts. You can reset passwords in 2 places: on the table of active and disabled accounts or on the individual user’s profile page (select their name in the table to get there).

    We’ll email the user a temporary password, which they’ll need to change upon login.

  • Update a user’s access to tax ID numbers (TINs)

    Manage your users’ access to tax IDs and the data connected to them. Access to a TIN includes all associated Blue Shield providers.

    To change a user’s TIN access, go to Account management > Manage user accounts, then find and select their name in the table to go to their profile page. Check or uncheck the boxes to update their TINs, toggle claims access to yes or no, and select Save.

  • Manage a user’s access to claims and real-time claims

    Claims: You can grant or restrict a user’s access to claims information for any tax ID (TIN). Claims access allows the user to search claim activity and check claim status associated with a tax ID number. Claims access also gives the user access to the professional fee schedule and the claims-routing tool.

    To change a user’s TIN access, go to Account management > Manage user accounts, then find and select their name in the table to go to their profile page. Select a TIN or TINs on the list, then toggle claims access to yes or no and select Save.

    Real-time claims: Also on the user’s profile page, you can grant access to real-time claims. This allows the user to file claims through the Real-time claims tool.

    To change claims access, slide the claims and real-time claims toggles to yes or no and select Save.

    Note: A user must have access to claims before you can give them access to real-time claims.

  • User access to eligibility and authorization information

    All users have access to this information for all their TINs by default. An account manager cannot restrict this access.

  • Activate or disable a user’s account

    To change a user’s account status, go to Account management > Manage user accounts, then find and select their name in the table. On their profile page, toggle their account status to active or disabled, then select Save.

    Pending: A new user account is pending until the user activates it. The user has 30 days to activate the account. After that, the system deletes it.

    If you have pending accounts, these appear on the Pending accounts table at the top of Manage user accounts. You can see the date each account will expire if the user doesn’t activate it. You can also send the user a new temporary password from here if they lose the original one.

    Active: This means a user can log in to their Provider Connection account and access all associated TINs.

    Disabled: A disabled account is inaccessible to the user but can be reactivated by the account manager. Disable an account for a user who’s going on leave, for example.

  • Delete an account

    To delete an account, go to Account management > Manage user accounts. Check the box next to the name of the user (or users) whose account you want to delete, then select Delete selected accounts, above the table. You’ll be asked to confirm before the account is deleted.

    Pro tip: Once you delete an account, it’s gone and cannot be retrieved. For a temporary solution, consider disabling the account instead.

  • Transfer user accounts to another account manager

    If you’ll be away from work, you need another account manager to assist your users while you’re gone. Transfer them to an account manager in your organization that shares access to the same TINs as the users.

    To transfer accounts, go to Account management > Manage user accounts. On the table of accounts, check the boxes next to the names you want to transfer and select Transfer selected accounts (above the table). If one or more account managers share the same tax IDs as the users, you can transfer your users.

    If no other account manager in your organization has access to the same TINs, have any account manager add the TINs to their own account at Account management > Manage your Provider Connection tax IDs. Then you can transfer your users to them.

    If there’s no other account manager in your organization, someone should create a Provider Connection account to register. It’s important to have a backup.

  • Edit a user’s profile information

    Only a user can edit their name, username, and contact information. They do this on their Manage my profile page.

  • Add or remove a tax ID number (for provider account managers)

    To manage the tax IDs connected with your Provider Connection account, go to Account management > Manage your Provider Connection tax IDs.

    To add a TIN, select Add tax IDs. To add some TINs, you need to provide information from one claim that’s:

    • Either Blue Shield of California or Promise Health Plan
    • From within the last 3 months

    For those claims, you need:

    • A check/EFT number, claim number, or member ID number
    • The check/EFT amount

    When you’ve successfully added the TIN, you’ll immediately have access to information associated with it.

    To remove a TIN from your Provider Connection account, find the TIN listed in the table and select Remove.

    Note: Adding and removing TINs on this page only affects your Provider Connection account. It doesn’t delete the records.

  • Request access to a tax ID number (for billing service managers)

    To manage the tax IDs connected with your Provider Connection account, go to Account management > Manage your Provider Connection tax IDs.

    To request access to a provider TIN, select Add tax IDs. You need:

    • The tax ID number of the organization you work for
    • Provider TINs you want to add
    • The Business Associate Agreement (BAA) date for each provider

    Once you request access, we immediately contact the provider. We'll email you when they approve your access. Then you’ll be able to access that TIN on Provider Connection. (If they deny your access, we’ll let you know that, too.)

  • Add or remove a tax ID number (for MSO account managers)

    To manage the tax IDs connected with your Provider Connection account, go to Account management > Manage your Provider Connection tax IDs.

    To add a TIN, select Add tax IDs. You need:

    • The tax ID number of the organization you work for
    • TINs of the providers you’d like to represent (usually a 9-digit Employer Identification Number [EIN], though individual providers can use their Social Security number)
    • The Business Associate Agreement (BAA) date for each provider

    For some provider TINs, you’ll also need a claim from within the last 3 months.

    When you’ve successfully added the TIN, you’ll immediately have access to information associated with it.

    To remove a TIN from your Provider Connection account, find the TIN listed in the table and select Remove.

  • Update a provider’s demographic information

    Provider and billing service account managers can update their provider’s information including contact info, specialties, and open hours at Account management > Provider demographic information. (MSO account managers can only view this information.) Select the pencil icon next to the section you want to update.

    We update the following information right away and display changes within 30 minutes of your request:

    • Phone number
    • Fax number
    • Email
    • Office hours
    • Accepting new patients
    • Wheelchair access
    • Telehealth services
    • Clinical staff languages
    • Medical interpreter languages
    • Areas of special expertise

    We must manually verify some information, and this takes time. Check back to see whether your changes have been processed. Information we must verify:

    • NPI
    • Primary specialty
    • Other specialties
    • Address

    To change any of the following demographic information, fill out this form (PDF, 1.1 MB) and email it to BSCProviderInfo@blueshieldca.com.

    • Name
    • Provider type (practitioner, IPA/medical group, facility, other)
    • PIN
    • PIN assignment date

    Note: This information is essential to our members, and keeping it up-to-date is quick and easy. Please help us serve them by keeping it current!

  • Are you an account manager?

    Every provider needs an account manager. Account managers are authorized to enter into legally binding contracts on behalf of their employers. Typically, an account manager works:

    • In a provider organization as an office manager or front-office staff
    • For a billing service or MSO hired by the provider

    An account manager:

    • Manages tax ID numbers (TINs) and Blue Shield provider identification numbers (PINs) associated with their organization
    • Creates user accounts for others in the organization, creates usernames, and resets passwords
    • Keeps the organization’s account information up-to-date

    To register as an account manager, you’ll be asked to sign a legal declaration.

  • Register as a Provider Connection account manager (provider)

    Providers deliver healthcare services to our plan members. They include doctors, hospitals, and medical groups.

    To register as a provider account manager, go to Log in/Create account. Creating your account should take about 5 minutes.

    Pro tip: When you register, look for the Need help? link available on each page. The step-by-step help that follows is available there, too.

    What you need

    Before you begin creating your Provider Connection account, be sure to gather:

    • The tax ID number (TIN) of every provider in your organization (usually a 9-digit Employer Identification Number [EIN], though individual providers can use their Social Security number)
    • For some, you need a claim from within the last 3 months

    Steps for creating an account

    Registering as a Provider Connection account manager has 4 steps:

    1. Choose your account type
    2. Enter the tax ID numbers (TINs) of your organization
    3. Enter contact info for your organization and yourself
    4. Select your username and password

    Step 1—Account type

    The type of account you’ll choose depends on what kind of organization you work for:

    • Provider
    • Billing service
    • Management services organization (MSO)

    Step 2—Tax ID numbers

    For security reasons, we must verify that you’re authorized to represent the TINs you register with. We use claim information to do that.

    For some TINs, you may need to provide information from one claim that’s:

    • Either Blue Shield of California or Promise Health Plan
    • From within the last 3 months

    For those claims, you need:

    • A check/EFT number, claim number, or member ID number
    • The check/EFT amount

    Want to register quickly? All you need to create your account is a single TIN with claim information. To finish creating your account faster, enter the information for just one TIN. You can always add more to your account after you log in.

    Step 3—Contact info

    Here you enter your organization’s address. You also enter your contact information, including your phone and email address.

    Step 4—Account setup

    You choose a username and password here. Then you must agree to our terms and conditions and sign a legal declaration.

    What happens next

    Before you can log in, we need to verify your email address. To do that, we’ll email you a link. The link expires, so follow it promptly. (If the link expires, you can request another one.) Then you’re ready to log in!

  • Register as a Provider Connection account manager (billing service)

    Billing services are hired by providers to handle billing and claims. They do not deliver healthcare services to our members. (If you work in a provider organization and handle billing, register as a provider account manager.)

    To register as a billing service manager, go to Log in/Create account. Creating your account should take about 5 minutes.

    Pro tip: When you register, look for the Need help? link available on each page. The step-by-step help that follows is available there, too.

    What you need

    Before you begin creating your Provider Connection account, be sure to gather:

    • The tax ID number (TIN) of the organization you work for
    • TINs of the providers you’d like to represent
    • The Business Associate Agreement (BAA) date for each provider

    Steps for creating an account

    Registering as a Provider Connection account manager has 4 steps:

    1. Choose your account type
    2. Enter tax ID numbers (TINs) for your organization and the providers you want to represent
    3. Enter contact info for your organization and yourself
    4. Select your username and password

    Step 1—Account type

    The type of account you’ll choose depends on what kind of organization you work for:

    • Provider
    • Billing service
    • Management services organization (MSO)

    Step 2—Tax ID numbers

    This step lets us connect your account to the information of your provider organizations.

    You need:

    • The tax ID number (TIN) of the organization you work for
    • TINs of the providers you want to represent
    • The Business Associate Agreement (BAA) date for each provider

    Step 3—Contact info

    Here you enter your organization’s address. You also enter your contact information, including your phone and email address.

    Step 4—Account setup

    You choose a username and password here. Then you must agree to our terms and conditions and sign a legal declaration.

    What happens next

    1. You need to verify your email address. We’ll email you a link right away.
    2. We immediately contact the providers whose TINs you want to access.
    3. When the first provider approves your access, we’ll email you. Then you’ll be able to access Provider Connection and information associated with that TIN.
    4. You’ll receive access to any additional TINs you requested as we get confirmation from those providers. (If they deny your access, we’ll let you know that, too.)
  • Register as a Provider Connection account manager (MSO)

    Management services organizations (MSOs) contract with providers to handle billing and other administrative services. Some MSOs own and manage the practices. They do not deliver healthcare services to our members.

    To register as an MSO account manager, go to Log in/Create account. Creating your account should take about 5 minutes.

    Pro tip: When you register, look for the Need help? link available on each page. The step-by-step help that follows is available there, too.

    What you need

    Before you begin creating your Provider Connection account, be sure to gather:

    • The tax ID number (TIN) of the organization you work for
    • TINs of the providers you’d like to represent (usually a 9-digit Employer Identification Number [EIN], though individual providers can use their Social Security number)
    • The Business Associate Agreement (BAA) date for each provider

    Steps for creating an account

    Registering as a Provider Connection account manager has 4 steps:

    1. Choose your account type
    2. Enter tax ID numbers (TINs) for your organization and the providers you want to represent
    3. Enter contact info for your organization and yourself
    4. Select your username and password

    Step 1—Account type

    The type of account you’ll choose depends on what kind of organization you work for:

    • Provider
    • Billing service
    • Management services organization (MSO)

    Step 2—Tax ID numbers

    For security reasons, we must verify that you’re authorized to represent the TINs you register with.

    For each TIN, you must enter:

    • The Business Associate Agreement (BAA) date of the provider

    For some TINs, you may need to provide information for one claim that’s:

    • Either Blue Shield of California or Promise Health Plan
    • From within the last 3 months

    For those claims, you need:

    • A check/EFT number, claim number, or member ID number
    • The check/EFT amount

    Want to register quickly? All you need to create your account is a single TIN with a BAA date and claim information. To finish creating your account faster, enter the information for one TIN. You can always add more after you log in.

    Step 3—Contact info

    Here you enter your organization’s address. You also enter your contact information, including your phone and email address.

    Step 4—Account setup

    You choose a username and password here. Then you must agree to our terms and conditions and sign a legal declaration.

    What happens next

    Before you can log in, we need to verify your email address. To do that, we’ll email you a link. The link expires, so follow it promptly. (If the link expires, you can request another one.) Then you’re ready to log in!

Technical issues

  • Compatible browsers and devices

    Provider Connection is designed to work in specific browsers. For the best experience, use the latest version of the following browsers:

    Windows OS computers

    • Google Chrome
    • Microsoft Edge
       

    Apple macOS computers

    • Google Chrome
       

    Some functionality on our website may not be compatible with Safari and Internet Explorer, as these browsers are not currently supported.

     

    Using Provider Connection tools and resources on smart devices

    The Provider Connection tools and informational pages are responsive and can be viewed and used on smart devices such as tablets.

     

    For technical assistance, submit a technical support request or contact us.

  • Contact us for assistance

    If you need help using the site, your Provider Relations Coordinator or Contract Manager can provide a demonstration of site features as well as assist you with the registration process.

    If you need help obtaining your Blue Shield provider ID number (PIN), call
    Blue Shield of California Provider Information and Enrollment at (800) 258-3091
    or Blue Shield Promise Provider Services at (800) 468-9935 [TTY 711], 8 a.m. to 5 p.m., Monday through Friday.

    For technical issues or problems, fill out a technical support form or contact us at (800) 541-6652.

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, 2.5 MB)

View reference guide for Blue Shield Promise providers (PDF, 1.5 MB)

Contact us

Find phone and fax numbers for Blue Shield corporate offices, provider and pharmacy services, medical management, EDI program and technical services as well as contact information for Provider Connection specific features.

Find contact information

Manage your profile

Manage your profile, get help with your username and password, or access Message center.

Manage profile

Access Message center