Claims
Learn how to submit claims electronically, search our Claims Fee Schedule for Blue Shield allowances, find resources on provider appeals and adjustments, and learn more about submitting claims, rules for payment and claim status.
How to submit claims
Learn how to submit claims to Blue Shield electronically.
Clean claims submission tips (PDF, 24 KB)
Check claim status
Check on the status of a claim searching by member name, dates of service and more.
Submit claims via Office Ally
Submit, correct and resubmit claims and manage payments online using Office Ally.
Clear Claim Connection (C3)
Use our simulation tool to prescreen claims, view claim auditing rules, payment policies, and more.
How to prescreen claims with C3 (PDF, 540 KB)
Introduction to Clear Claim Connection (C3) (PDF, 816 KB)
Submit via SympliSend
Upload first time paper claims with attachments and respond to itemization requests for claims in process.
How to use SympliSend Portal (PDF, 1 MB)
Enroll in EDI
Enroll in EDI for your organization, either through a clearinghouse or directly with Blue Shield.
Encounters resources
Learn about submission requirements, monthly performance summary reports and more.
View facility fee schedules
Access outpatient facility fee schedules for ASCs and hospitals.
About pharmacist professional services and claims submission
Learn how pharmacists submit medical claims for professional services provided to Blue Shield of California members.
Provider disputes for Blue Shield of California Health Plan
Get details on the dispute filing process, including how to submit online or by mail.
Provider disputes for Blue Shield of California Promise Health Plan
Get details on the dispute filing process, including how to submit by mail.
View submitted disputes
Search disputes you've submitted online and by mail. You can also check status and view letters.
No Surprise Billing Act
Begin an open negotiation to dispute a claim covered by this act. This is typically for out-of-network providers.
Ancillary claims filing
Review claim submission requirements for Blue Shield of California labs, specialty pharmacy and DME providers.
NCCI edits – physicians and hospitals outpatient
Learn about clinical coding edits for physicians & outpatient hospitals.
Medications
View a list of Richman Injectables (high-cost, adult, childhood, etc.), Gene and Cell Therapy agents (including CAR-T) and Behavioral Health medications.
National Drug Code requirements for physician administered drugs
Find requirements and drug list for encounters for Blue Shield Promise members.
Claims contacts
See phone numbers, addresses, and more.