This page contains recorded webinars, eLearning modules, FAQs, and step-by-step tutorials to help you serve Blue Shield and Blue Shield Promise Health Plan members, and work with Blue Shield effectively and efficiently.

Topics:
Blue Shield products, plans and networks
Claims and billing
Patient care
Provider data management
Pharmacy
Quality improvement

Blue Shield products, plans and networks

Plan Closures and Transitions to Medicare Advantage HMO and D-SNP Plans

The Blue Shield Coordinated Choice (HMO) plan and all Blue Shield Promise Cal MediConnect (CMC) plans end December 31, 2022. All members will automatically transition into an existing Blue Shield Medicare Advantage Prescription Drug Plan or Dual Eligible Special Needs Plan (D-SNP) as of January 1, 2023. This webinar explains these changes.
Recorded webinar (50 min)
Presentation (PDF, 3.3 MB)
Frequently asked questions (PDF, 1 MB)

2023 Blue High Performance Network

Blue Shield of California’s Blue High Performance NetworkSM (BlueHPNSM) is a national exclusive provider organization (EPO) alternative to the BlueCard PPO Network offered to employer groups. BlueHPN providers offer care to Blue Shield of California members, as well as out-of-area members who purchase this coverage through other Blue Plans. To learn more, click this link to access a quick interactive module.
Blue High Performance Network

Blue Shield plans and networks

A list of plan and network names for Blue Shield of California 2023 HMO, PPO, POS, EPO, and Medicare Advantage products.
2023 Blue Shield benefit plans and networks (PDF, 1 MB)

2023 Blue Shield Tandem PPO Network Resource Guide

Blue Shield’s Tandem PPO Network and Full PPO Network are different. This guide explains how to determine if you are contracted for participation in the Tandem PPO Network. If yes, the tools and tips contained within this guide will help you identify Tandem PPO plan members, whether your practice location can provide in-network services, and how to file claims to be accurately reimbursed.
Resource Guide (PDF, 2 MB)

Revised California Mental Health Parity Act (effective January 1, 2021)

This interactive tool is a quick way to learn about key updates to the law.
Revised California Mental Health Parity Act

Individual Medicare Advantage Prescription Drug Plans and Benefits Changes

Learn about 2021 changes to Medicare Advantage plans including Blue Shield Promise’s Medicare Contract, H5928, transfer to Blue Shield of California.
2021 Individual Medicare Advantage Prescription Drug Plans and Benefits Changes
Recorded Webinar (30 min)
Presentation (PDF, 945 KB)

California Blue plans explained

Learn the differences between the two Blue plans in California from this one-page infographic:
Who’s who in the world of Blue (PDF, 203 KB)

Medicare Advantage Coordination of Care Program

This interactive toolkit explains the requirements of Blue Shield network PPO participants providing care for BCBS Medicare Advantage members.
Blue Cross Blue Shield (BCBS) Medicare Advantage Coordination of Care PPO Program (5 minutes)

Medicare PPO Tools and Tips Guide for Providers

If you are a participating in Blue Shield’s Medicare Advantage PPO provider network, this tool kit is designed to help to you when you are providing services for our Medicare Advantage PPO plan members.
Blue Shield Medicare PPO Tools & Tips Guide for Providers (PDF, 879 KB)

Specialty Care Reimagined Operations Manuals for program providers

Gastroenterology (PDF, 5 MB)
OB/GYN – Maternity (PDF, 4 MB)
Orthopedics (PDF, 7 MB)

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Claims and billing

Updates for Blue Shield Promise Skilled Nursing Facility providers (December 2022)

This video covers benefits coordination, authorizations, claims, and billing in compliance with APL 22-018: Skilled Nursing Facilities - Long Term Care Benefit Standardization and Transition of Members to Managed Care. View and download the PDF for additional links to helpful resources.
Video (20 min)
Presentation (PDF, 1.4 MB)

Collecting Social Determinants of Health (SDOH) Data

Blue Shield of California Promise Health Plan uses specified SDOH Z codes to better target enhanced care management and community support programs to improve patient health, lessen disparities, deliver social benefits, and reduce healthcare utilization without impacting provider capitation payments. To learn more, click this link to access a quick interactive module for clinicians and staff.
Collecting Social Determinants of Health Data

Improving Provider Encounter Data – 2023

Find out how you and your staff can improve the quality of encounter data submissions.
Recorded webinar (29 min)
Presentation (PDF, 288 KB)

Improving Provider Encounter Data – October 2022

Find out how you and your staff can improve the quality of encounter data submissions.
Recorded webinar (12 min)
Presentation (PDF, 477 KB)

Submitting claims with taxonomy codes tutorial for Blue Shield and Blue Shield Promise providers

Taxonomy codes are required to identify provider specialties when filing claims. It is critical for multispecialty groups and dual-licensed providers to properly bill with taxonomy codes. This one-page job aid illustrates how do that, whether you are filing on the CMS 1500 form or electronically.
Clean claims submission tips for professional providers (PDF, 24 KB)

Using Clear Claim Connection (C3) to prescreen claims

Learn how to use the Clear Claim Connection (C3) simulation tool to test HCPCS/CPT codes and view clinical edits with rationales.
How to prescreen claims with C3 (PDF, 540 KB)

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Patient care

Advance Care Planning: Tools for Starting the Conversation (10/2022)

Dr. Kimberly Bower shares insights, best practices, and tools for starting the advance care planning conversation with patients facing serious illness. Additionally, Dr. Bower provides an overview of Blue Shield’s Home-Based Palliative Care Program.
Recorded webinar (54 min)
Presentation (PDF, 2.9 MB)

Racism in American Medicine

Dr. Tina Sacks, Assistant Professor at UC Berkeley School of Social Welfare, and Dr. Lily Lamboy, Director of Diversity, Equity, and Inclusion at Blue Shield of California, discuss the latest research in health inequities and social determinants of health, and share insights from Blue Shield of California’s patient grievance data.
Recorded webinar (54 min)
Presentation (PDF, 683 KB)

To earn enduring Continuing Medical Education (CME) credits by viewing this webinar, visit Scripps Health

Children’s Health Program

This webinar covers the services, eligibility criteria, and intake procedures for three statewide programs serving Medi-Cal eligible individuals with disabilities: California Children’s Services, Department of Developmental Services (DDS), and DDS’ Early Start programs.
Recorded webinar (56 min)
Presentation (PDF, 668 KB)

2022 Mandatory Care Coordination Annual Training

This course includes information about Long Term Services and Supports and other programs, social services case management, ADA accessibility and accommodations, Interdisciplinary Care Team, Critical Incident Reporting and more.
E-Learning course
Course PDF (PDF, 1.5 MB)
Attestation Form

2022 Person-Centered Care Planning for Supporting Self-Direction

This training contains an overview of Person-Centered Care Planning as well as principles and examples of self-direction.
E-Learning course
Course PDF (PDF, 283 KB)
Attestation Form

Implicit Bias in Healthcare and What You Can Do About It

Implicit bias refers to the brain’s instant association of attitudes or stereotypes toward groups without our conscious awareness. It can have the least obvious but most devastating impact on health equity. This interactive module is a quick way for clinicians and office staff to recognize and mitigate implicit bias.
Implicit Bias in Healthcare and What You Can Do About It

Improve Practice Efficiencies and Patient/Provider Joy by Asking, “What matters to you?” (August 2021)

“What Matters to You” (WMTY) is a simple question having a big impact on care quality, safety, and efficiency. This webinar provides practical and proven strategies for integrating WMTY into busy clinical practice settings.
Recorded webinar (43 min)
Presentation (PDF, 2.7 MB)

Rapid Whole Genome Sequencing in the NICU: Faster Diagnosis. Better outcomes. Reduced healthcare costs. (March 2021)

Blue Shield of California covers rapid and ultra-rapid whole genome sequencing (rWGS) for qualifying babies and children with life-threatening and unexplained medical conditions. In this webinar, clinicians from Rady Institute of Genomic Medicine explain clinical and operational components of rWGS.
Recorded webinar (50 min)
Presentation (PDF, 2.2 MB)

What your Lesbian, Gay, Bisexual, Transgender, and Questioning patients would like you to know (February 2020)

This webinar covers practical guidelines and considerations for providing inclusive health care to your LGBT/Q patients. Topics include creating a welcoming environment for LGBT/Q patients, using non-judgmental questions, and using language preferred by LGBT/Q patients.
Recorded webinar (1.5 hours)
Presentation (PDF, 1.3 MB)

Talking with Older Patients about Sensitive Topics

It can be difficult to talk with older patients about sensitive topics such as bladder control and sexual health. Brandon K. Koretz, MD, MBA, Professor of Clinical Medicine and Co-Chief, Division of Geriatrics at UCLA Health provides practical and proven strategies for addressing these topics.
Recorded webinar (45 min)
Presentation (PDF, 312 KB)

Fall Prevention

Integrating fall prevention into clinical practice includes ensuring that everyone on staff is informed and involved. This 10-minute interactive module is designed to help medical office and hospital staff get up-to-speed on fall prevention best practices.
Stop a fall, save a life: Integrating fall prevention into practice

There is such a wealth of fall prevention material online that it can be time consuming for providers to find what they need. Blue Shield has curated this set of online resources for quick and easy access to the best information, including resources to share with patients.
Stop a fall, save a life: Fall prevention resource list (PDF, 128 KB)

Stop a Fall, Save a Life: Integrating Fall Prevention into Practice

Dr. Diana Homeier – Associate Professor at the Keck School of Medicine of USC and Medical Director at LAC+USC Geriatric Clinic and Adult Protection Team – presents practical, proven strategies for changing the way your practice approaches fall prevention.
Recorded webinar (50 min)
Presentation (PDF, 2.23 MB)

Providing Senior-Friendly Service

This 15-minute senior sensitivity elearning course gives participants the opportunity to gain knowledge, adopt attitudes, and modify behaviors that contribute to improving our senior patients’ experience.
Provider Senior-Friendly Service elearning

Patient/Physician Medical Appointment Summary Form

A non-branded form designed to help facilitate patient/physician communication during the medical appointment. It was created for Medicare patients, but should be helpful for all patients you see. Page 1 is completed by the patient and captures the visit reason and current health status. Page 2 is an after-visit summary completed by the doctor and provided to the patient as a takeaway.
Online appointment summary form (PDF, 155 KB)
Hard copy appointment summary form (PDF, 38 KB)

Referring Patients to Home-Based Palliative Care

This webinar describes how providers can refer qualified patients to Blue Shield’s Home-Based Palliative Care (HBPC) program. The session covers  HBPC patient eligibility requirements, the referral process, HBPC services provided as part of the program, and resources available to support referring providers. 
Recorded webinar (48 min)
Presentation (PDF, 1.8 MB)
Webinar FAQ (PDF, 54 KB)

Home-Based Palliative Care Program Overview for Servicing Providers (2019)

This webinar describes Blue Shield’s home-based palliative care program from the perspective of a servicing provider. Topics included how to qualify and enroll patients, how to code and bill for hassle-free payment, and more.
Recorded webinar (48 min)
Presentation (PDF, 775 KB)

Use the tool below to qualify Blue Shield members for the Home-Based Palliative Care (HBPC) Program. Only members meeting the criteria outlined in this tool can be enrolled in the program.
HBPC Program Patient Eligibility Screening Tool (PDF, 105 KB)

This one-page job aid captures key steps that servicing providers should follow when assessing, enrolling, and caring for members in the HBPC program.
HBPC Program Servicing Provider Checklist (PDF, 199 KB)

The support documents below are provided to help servicing providers meet program requirements.
CMS 1500 Claim Form Sample (PDF, 177 KB)
CMS 1500 Claim Form Sample – PMPM (PDF, 180 KB)
HBPC Program UB Sample – Initial Evaluation (PDF, 1.2 MB)
HBPC Program UB Sample – PMPM (PDF, 1.2 MB)

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Health literacy

Addressing low health literacy – Improve patient outcomes without adding time (February 2021)

Dr. Cliff Coleman, MD, MPH, a national expert in health literacy, presents communication best practices designed to improve patients’ understanding while not adding time to healthcare professionals’ busy workloads.
Recorded webinar (59 min)
Presentation (PDF, 885 KB)

To earn enduring Continuing Medical Education (CME) credits by viewing this webinar, visit Scripps Health.

Improving health literacy with plain language

In this 10-minute interactive module, you will learn why health literacy is important. And by the end, you’ll have the information and tools you need to use plain language as part of good health literacy practices.
Health literacy eLearning

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Provider data management

How to attest or update your provider directory information

Per federal and state law, contracted providers, facilities, and practitioners must attest to the accuracy of their provider directory information every 90 days and update that information if it changes. Blue Shield providers are required to attest and update via the Provider Connection website. This document explains how to do both, as well as how to establish a Provider Connection account for your organization and/or troubleshoot access issues.
Step-by-step instructions (PDF, 285 KB)
Instructional video (14 min)

Provider Data Validation Spreadsheet (blank)

If you do not want to download a pre-populated spreadsheet from Provider Connection to submit an update, you can use this blank version. Either enter delta data (changes only) or a full set of your data into the document, save, and upload the file, following the instructions above and on Tab 1 of the spreadsheet. You must retain all field names and data elements in the file and follow the appropriate naming convention and instructions.
Provider Data Validation Spreadsheet (Excel, 50 KB)

Treatment Cost Estimator, Provider Data Review

Blue Shield's Treatment Cost Estimator is an online tool that assists PPO members in making informed healthcare choices by enabling them to compare cost estimates for selected network medical treatments and services. Members can also view options such as non-invasive treatment, and timelines to help them plan for healthcare needs in partnership with their providers.

With the backing of California legislation, including Senate Bill 1340, the transparency in health care supported by our Treatment Cost Estimator promotes shared decision-making between patients and their healthcare providers.

Our PPO network providers will receive the Provider Cost Estimate Report twice a year listing their cost estimate data that will be included in the Treatment Cost Estimator. Providers are encouraged to review this data. Here are some resources to help.
How to Read the Provider Cost Estimate Report (PDF, 106 KB)
Provider Cost Estimate Report FAQs for professional providers (PDF, 43 KB)
BlueCross BlueShield Cost Estimate Methodology for professional providers (PDF, 84 KB)
Cost Estimate Report FAQs for facilities (PDF, 42 KB)
BlueCross BlueShield Cost Estimate Methodology for facilities (PDF, 98 KB)

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Pharmacy

Biosimilars: A Safe and Effective Option for Patients

This interactive module is a quick way for physicians to review:

  • The advantages of biosimilars
  • FDA regulatory processes
  • How to reduce the Nocebo Effect
  • Blue Shield’s preferred drug list
  • Drug-specific data

Biosimilars

Medication Selection Considerations for Medication-assisted Treatment (MAT)

MAT is one of the most effective interventions to combat opioid use disorders (OUD). Blue Shield pharmacists Tamara Tran and Stephen Jung discuss criteria and guidelines for MAT medication selection.
Recorded webinar (40 min)
Presentation (PDF, 744 KB)

Your Patient Suffered a Non-fatal Overdose...Now What? (NSI, 2019)

Dr. Andrea Rubinstein – anesthesiologist and Chief of Kaiser Permanente’s Santa Rosa Department of Pain Medicine – presents scenario-based strategies for how to reduce the risk of subsequent overdose in chronic pain patients who use opioids.
Recorded webinar (1 hour, 5 min)
Presentation (PDF, 2.33 MB)

Non-Pharmacological Approaches to Chronic Pain Management (NSI, 2018)

Dr. R. Corey Waller looks at the evidence behind complementary and alternative medicine approaches that may be helpful in chronic pain management.
Recorded webinar (1 hour 5 min)
Presentation (PDF, 862 KB)

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Quality improvement

How to get better CAHPS ratings

Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys measure patient experience for all health plans and products. The Centers for Medicare and Medicaid Services (CMS) announced that CAHPS will be weighted four times more starting in 2021. This interactive module is a quick and easy way for front office staff, clinicians, and physicians to learn what influences CAHPS scores and offers tips for how to improve.
CAHPS e-learning

What you need to know about the CAHPS Health Plan Survey

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey is a national, standardized survey used for measuring and reporting information on member experiences with health plans and their contracted providers. Read this overview to learn how patients’ perception and responses can impact value-based care and ultimately your practice.
CAHPS Fact Sheet (PDF, 53 KB)

Provider Tips for Positively Impacting HOS Scores (2023)

This job aid focuses specifically on Hospital Outcome Survey (HOS) measures and provides recommendations for enhancing scores.
Job aid (PDF, 79 KB)

Mission Possible! Simple Strategies for Improving Medication Adherence

Dr. R. James Dudl shares simple, evidence-based ways to improve medication adherence.
Recorded webinar (50 min)
Presentation (PDF, 1.53 MB)

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