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Claim issues & disputes

Find resources and information here regarding provider disputes, including an overview of the dispute process, instructions, and details about filing online.

Blue Shield of California is committed to providing a fair and transparent provider dispute resolution process. However, the dispute process is not intended to address claim corrections, requests for claim information, or inquiries about claim decisions, procedures, and payment rules.

We may be able to help remedy a claim issue before you file a formal dispute. Your options are:

  • Correcting a claim
    Submit corrected claims within 30 working days of receiving a request for missing or additional information.
  • Making an inquiry or contacting Provider Service
    If you have questions about a specific claim, contact us. Customer service can help clarify claim decisions, procedures, and payments. They may alter original claim decisions.

If we’re not able to resolve your claim issue and you consider it necessary to file a dispute, start online.

File a dispute online

Have a question? See FAQs or step-by-step instructions.

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File a dispute by mail

Find paper dispute resolution forms, filing instructions, and mailing addresses. 

Get forms and instructions

Submitted disputes

Get information about disputes you’ve submitted within the last 3 years.

View disputes

Disputes covered by the No Surprise Billing Act: The act requires that insurers and out-of-network providers resolve medical service and emergency room facility claims via open negotiation. Submit the Open Negotiation Notice form to initiate the process.

Dispute review process and guidelines

Filing a dispute correctly is the best way to ensure a quick resolution. The dispute process is reserved for requesting payment reconsideration for claims that have been denied, paid at less than billed charges, or otherwise contested.

Learn more about the dispute process

For Blue Shield of California Promise Health Plan providers

Learn about the dispute process for Blue Shield Promise providers.

Read Blue Shield Promise provider dispute resolution policies

Refund requests for Blue Shield of California providers

Get information on scenarios that might result in overpayments and how to process refund requests.

Learn more about refund requests

Professional fee schedule for Blue Shield of California providers

Search the professional fee schedule for Blue Shield of California allowances and learn how we establish them.

Learn more about professional fee schedule

Payment policies and rules

Read an overview of payment processing policies and rules.

Learn more about our payment policies