Visit this page to find information about programs, resources, and contacts available at Blue Shield of California and Blue Shield of California Promise Health Plan. We are here to assist you in submitting and managing encounters and other information as you provide services to our members.
We will also periodically update the Frequently Asked Questions about encounters, available to view or download at the link below.
Programs and Contacts
Value Incentive Program (VIP)/ Promise Quality Performance Incentive (PQPI) for Blue Shield Promise
Effective 2022, the Promise VIP Program is now called Promise Quality Performance Incentive (PQPI). Encounter data is crucial for demonstrating accurate quality performance to the Department of Health Care Services (DHCS).
Encounter data performance also impacts two major provider incentive programs:
- L.A. Care’s Value Initiative for IPA Performance (VIIP) + Pay for Performance (P4P) Program
- Promise Health Plan’s Value Incentive Program (VIP) – San Diego and Los Angeles
The PQPI is a traditional pay for performance program based on annual measurement of IPA performance in various domains.
- Performance measurement is primarily focused on Healthcare Effectiveness Data and Information Set (HEDIS®) measures that assess quality of health care provided to Blue Shield Promise Medi-Cal members.
- Automatic enrollment – All IPAs who serve Blue Shield Medi-Cal members are automatically enrolled in the PQPI program. There is no need to “sign up.”
- Pure bonus – Incentive payments are upside only and serve as a pure bonus that is not tied to contractual agreements.
If you have questions, please reach out to the Provider Incentive team at Providerincentives@blueshieldca.com
Electronic Data Interchange Team
If you have questions about electronic data interchange (EDI) submissions, we are here to assist you:
- Blue Shield of California EDI Platform Services Team at (800) 480-1221 for commercial and Medicare business
- Blue Shield of California Promise Health Plan EDI Platform Services Team at (800) 480-1221 for Medi-Cal business