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

Initial disputes 

Initial disputes must be submitted within 365 days, or the time specified in the provider's contract, whichever is greater, of Blue Shield's date of contest, denial, notice, or payment.  

If a dispute involves a lack of a decision, it must be submitted within 365 days, or the time specified in the provider's contract, whichever is greater, after the time for contesting or denying a claim has expired. 

Final disputes

Providers or capitated entities who disagree with Blue Shield's initial determination may pursue the matter further by submitting a final dispute within 65 working days of Blue Shield’s initial determination, or the time specified in the provider’s contract, whichever is greater. 

Final disputes must be submitted with the same required information as initial disputes. 

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 Blue Shield of California Promise Health Plans

Submit disputes regarding Blue Shield Promise plans in writing to: 

Blue Shield of California Promise Health Plan  
Attn: Provider Dispute Resolution Department  
P.O. Box 3829  
Montebello, CA 90640 

 Acknowledgement  

  • For disputes submitted online, we’ll notify you via email within 2 working days when a letter acknowledging receipt of the dispute is ready to view on Provider Connection. 
  • For disputes submitted by mail, we’ll notify you with a letter acknowledging receipt of the dispute within 15 working days.  

Resolution 

  • We resolve disputes within 45 working days of receiving them. 
  • Disputes that are returned due to missing information are resolved within 45 working days of receiving an amended dispute with missing information. 
  • If the resolution of a dispute results in funds due to a provider, we’ll issue a payment, including interest when applicable, within 5 working days of the date of the written notice of the dispute resolution.  
  • In most cases, if you disagree with a determination, you have 65 working days to start a final dispute.  

Find completed dispute forms, supporting documents, and acknowledgement and determination letters to view and download on Provider Connection.