Find resources and information regarding filing provider disputes by mail, including dispute resolution forms and where to send them. You can also file most provider disputes 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.

How to file a dispute by mail 

Blue Shield of California healthcare providers can file disputes by printing, filling out, and mailing the appropriate provider dispute resolution form to the right address. Find forms and mailing addresses below. 

A dispute submitted in writing must contain the following information: 

  • The provider's name 
  • The provider's identification number: The Blue Shield Identification number (PIN) or the provider's tax or Social Security number 
  • Contact information: Mailing address and phone number 
  • Blue Shield's Internal Control Number (ICN), when applicable 
  • The patient's name, when applicable 
  • The patient's Blue Shield subscriber number, when applicable 
  • The date of service, when applicable 
  • A clear explanation of issue the provider believes to be incorrect, including supporting medical records when applicable 
  • As applicable, bundled disputes must identify individually each item by using either the ICN or the section of the contract and sequential numbers that are cross-referenced to a document or spreadsheet 

To learn about the dispute review process, go to the Dispute review process and guidelines page.

Dispute resolution forms 

Download dispute resolution forms 

Where to send dispute resolution forms

Initial disputes 

Submit initial disputes in writing to: 

Blue Shield Initial Dispute Resolution Office 
P.O. Box 272620 
Chico, CA 95927-2620 

Submit disputes regarding facility contract exceptions in writing to: 

Blue Shield Initial Dispute Resolution Office 
Attention: Hospital Exception and Transplant Team 
P.O. Box 629010 
El Dorado Hills, CA 95762-9010 

Final disputes 

Submit final disputes in writing to: 

Blue Shield Final Provider Dispute and Resolution Office 
P.O. Box 629011 
El Dorado Hills, CA 95762-9011 

For Medicare Advantage Plans

Submit disputes in writing to:

Blue Shield Provider Dispute Resolution
Attn: Medicare Advantage
P.O. Box 272640
Chico, CA 95927-2640

For Blue Shield of California Promise Health Plans

Submit disputes regarding Blue Shield Promise plans in writing to: 

Blue Shield of California Promise Health Plan  
FirstSource PHP PDR  
265 Airpark Blvd Ste 100  
Chico, CA 95973