Stay informed about programs, policies, and announcements issued this year by Blue Shield of California and Blue Shield of California Promise Health Plan.
Recent announcements for Blue Shield Promise providers
Recent announcements for Blue Shield providers
Pharmacy claim vendor change effective January 1, 2021
October 30, 2020 - Effective January 1, 2021, Blue Shield of California and Blue Shield of California Promise Health Plan will transition from SS&C to CVS Health (CVSH) for pharmacy claim processing and related services for all lines of business. The transition to CVSH and enhanced data security will require each user to register with a personal login and password to access CALINX Rx data. Providers can continue to obtain CALINX Rx pharmacy claims data using the current SS&C process through January 31, 2021.
Read notice (PDF, 70 KB)
Provider Connection Enhancements
October 29, 2020 - We are pleased to announce the latest enhancements to the Provider Connection website! Changes include sitewide search capability, a new claim activity dashboard, pinned claims functionality, and account management filtering and sorting. Registered Billing Service Managers can now request additional Tax ID access online. Also, the Account Manager’s Responsibilities section is now a one-stop shop for all activities an Account Manager may do. Please check the revised Provider Connection Reference Guide for information about these enhancements.
View guide (PDF, 2.42 MB)
Matching primary care physicians with PPO members
October 19, 2020 - Effective January 1, 2021, Blue Shield of California will match all PPO members to a primary care physician (PCP) in their PPO network. These practitioners must be practicing in the specialties of Family Medicine, Internal Medicine, General Practice, or Pediatrics, and must meet other Blue Shield business rules to be eligible for this role. Auto-assignment of PCPs has already taken place during 2020 for members of the Blue Shield IFP PPO and Tandem PPO plans.
The purpose of matching PCPs to PPO members is to encourage coordination and management in order to enhance overall patient care. Once matched, members may then select a different PPO PCP from those eligible, if they wish to make that change. Blue Shield full PPO members may select an OB/Gyn as their PCP, if desired.
View the FAQ (PDF, 117 KB)
Blue Shield of California Inspire (PPO) 2021 Summary of Benefits Matrix
October 18, 2020 - The 2021 Summary of Benefits matrix for Blue Shield of California Inspire (PPO) Medicare Advantage plan that Blue Shield is offering in Alameda County, is available to download.
Review the summary (XLSX, 63 KB)
New Real-Time Claims web tool part of claims automation initiative
September 29, 2020 - As part of an ongoing initiative to transform and automate the claims submission process, Blue Shield of California is launching a new Real-Time Claims web tool. Available on Provider Connection, Real-Time Claims functionality allows Blue Shield commercial providers to create estimates and submit claims in seconds.
View the FAQ (PDF, 82 KB)
Blue Shield of California’s Health Reimagined Supports Ongoing Innovation and Helps Address Hardships Exposed by COVID-19
June 25, 2020 - Blue Shield of California is working closely with medical providers, local and regional stakeholders, and collaborating with technology firms to bring the best ideas and solutions to the market. Learn how this effort addresses long-standing access, equity, cost and quality issues that have been further exposed during the COVID-19 pandemic.
Learn how Blue Shield is transforming health care
Blue Shield of California is collaborating with Cricket Health to provide kidney care
June 24, 2020 - In Q3, Blue Shield of California and Cricket Health are planning to launch a collaborative care coordination program to bring Cricket Health’s kidney care services to eligible Blue Shield PPO members who have late-stage chronic kidney disease (CKD) or end-stage renal disease (ESRD) – at no extra cost to them.
Cricket Health’s services augment care provided by a Blue Shield member’s current primary care physician, nephrologist, or other specialists. We believe that offering these additional kidney care services will help Blue Shield members to better manage their condition so they can make informed decisions and improve their quality of life.
To learn more about Cricket Health’s services, we invite you to visit our interactive, online FAQ.
View the FAQ
Provider Connection Update
June 16, 2020 - We are pleased to announce the latest update to our Provider Connection website! The following enhancements are now available for use: additional account managers; revised member roster; updated member eligibility search tool; new registration process for billing services; and an updated security experience.
As part of this update, we are enabling our Blue Shield of California Promise Health Plan providers to register and access information on the Provider Connection website.
Please check the revised Provider Connection Reference Guide for information about these enhancements.
View guide (PDF, 2 MB)
Medication Policy and Formulary Updates 2nd Quarter 2020
May 7, 2020 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 191 KB)
Specialty Preferred Drug List for Medical Benefit Update
April 1, 2020 - View a summary of the Specialty Preferred Drug List for Medical Benefit update.
View summary (PDF, 47 KB)
Medication Policy and Formulary Updates 1st Quarter 2020
February 6, 2020 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 153 KB)