News and announcements

Changes to preferred drugs and reimbursement rates, effective April 1, 2022

April 1, 2022 - Beginning today, Inflectra and Avsola will be Blue Shield of California’s preferred infliximab products. Fulphila will become a preferred pegfilgrastim product and Udenyca will move to a non-preferred status. Additionally, the reimbursement rate for infliximab, bevacizumab, trastuzumab, and rituximab biosimilar preferred alternatives will increase for Blue Shield PPO commercial plan members.
Read FAQ (PDF, 101 KB)

Specialty Preferred Drug List for Medical Benefit Update

April 1, 2022 - View a summary of the Specialty Preferred Drug List for Medical Benefit update.
View summary (PDF, 33 KB)

Site of Service Program Policy Drug List Update

March 1, 2022 - View Site of Service Program drug list update.
View drug list (PDF, 30 KB)

Claims pages updated on Provider Connection

February 15, 2022 - Blue Shield of California Provider Connection claim pages now have an updated, streamlined layout with more helpful information all in one place.
Learn about updates (PDF, 102 KB)

Medication Policy and Formulary Updates 1st Quarter 2022

February 6, 2022 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 164 KB)

Changes to Provider Connection for BlueCard claims

January 25, 2022 - Now it’s easier for providers to access information for patients insured by Blue plans in other states. Providers can view available letters related to a BlueCard claim and request status, eligibility, and benefits information directly from the claims page.
View more details (PDF, 81 KB)

Preparing for provider directory updates mandated by the 2021 Consolidated Appropriations Act

November 16, 2021 - Blue Shield of California is preparing to support the 2021 Consolidated Appropriations Act (CAA) provider directory requirements that will take effect on January 1, 2022. We invite our network participants to prepare as well, by registering for Provider Connection and learning more about what actions will be required.
Read frequently asked questions (PDF, 97 KB)

Recent enhancements to Provider Connection Claims section

October 12, 2021 - We’ve updated the Claims pages on the Provider Connection website to make it easier to find claims and view more of them at once. Log in and visit the Check claims status landing page to take a tour!
Go to Check claim status

New extended hours for Provider Information & Enrollment – 6 a.m. to 6:30 p.m.

October 4, 2021 - The Blue Shield of California Provider Information & Enrollment team is now available to assist you between the hours of 6 a.m. and 6:30 p.m., Monday through Friday, at (800) 258-3091. After hours and during the weekend, our automated system will receive your calls and offer guidance. Please do not hesitate to reach out if you need assistance.

New Visits Accumulator functionality

September 27, 2021 - The Visits Accumulator, found in the Eligibility & benefits section of Provider Connection, tracks a member’s visits to specialty providers when their plan covers a set number of visits per plan year. The Visits Accumulator tracks chiropractor, acupuncture, occupational therapy (OT), physical therapy (PT), respiratory therapy (RT) and combined visits for the current plan year and the member’s most recent prior plan year. Note that the Visits Accumulator only tracks visits that are paid by Blue Shield. Specialty visits that are covered by third parties such as American Specialty Health (ASH), Medi-Cal, or Medicare will not be tracked by the Visits Accumulator.
Read the Reference Guide (PDF, 2476KB)

Use the new BlueCard address for claims sent to Blue Shield of California for services provided in California

August 24, 2021 - Earlier this year, we have assigned a new mailing address for receiving your BlueCard claims for services you provide within California to Blue Plan members. Please be certain to use the address below when sending BlueCard claims for services provided in California. New and current BlueCard claims mailing address: Blue Shield of California BlueCard Program P.O. Box 272630 Chico, CA 95927-2630 We want to provide you with accurate and timely service. Although some BlueCard claims sent to the former mailing address at Blue Shield have been forwarded to the new mailbox, we are hearing that some are NOT being forwarded due to “no forwarding” directives or other reasons. We strongly urge you to begin using the new address immediately to ensure your claims are received by Blue Shield as quickly as possible.

Medication Policy and Formulary Updates 3rd Quarter 2021

August 5, 2021 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 168 KB)

How to download members’ ID cards

June 11, 2021 - Blue Shield of California providers can easily download members’ ID cards to access the information they need, saving time and reducing environmental waste. We’ve posted a 1-page resource on Provider Connection to show you how. (Login required.)
See instructions (PDF, 40KB)

Medication Policy and Formulary Updates 2nd Quarter 2021

May 6, 2021 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 175 KB)

Provider Connection Enhancements

April 14, 2021 - We are pleased to announce the latest enhancements to the Provider Connection website! Changes include improved web page design in several areas, and the ability for Account Managers to use the Provider Demographics page to update the practice information that appears in the Find a Doctor tool. We also added two new features to the Real-Time Claims web tool: service line split (unbundling) and a self-referral option. Please check the revised Provider Connection Reference Guide for information about these enhancements.
View guide (PDF, 2.2 MB)

New extended hours for Provider Services – 6 a.m. to 6:30 p.m.

March 16, 2021 - The Blue Shield of California Provider Services team is now available to assist you between the hours of 6 a.m. and 6:30 p.m., Monday through Friday, at (800) 541-6652. After hours and during the weekend, our automated system will receive your calls and offer guidance. Please do not hesitate to reach out to Provider Services if you need assistance.

Kidney Care Program for Medicare Advantage HMO and PPO plan members

March 15, 2021 - In the second quarter of 2021, Blue Shield of California plans to launch a kidney care program for eligible Blue Shield Medicare Advantage HMO and PPO plan members who have late-stage chronic kidney disease (CKD) or end-stage renal disease (ESRD). The program will be offered at no extra cost to the members, to augment care provided by their current primary care physician, physician of choice, nephrologist, or other specialists during the time between patient visits.
Read the FAQ (PDF, 90 KB)

Real-Time Claims web tool enhancements

February 11, 2021 - The Real-Time Claims web tool, available on Provider Connection, has recently been updated to include: the ability to print estimates and claims; error messages; NPI search capability; copay field; dashboard manual refresh; and the ability to manually expire an estimate. Please refer to our Frequently Asked Questions document to learn more about the Real-Time Claims web tool.
View the PDF (PDF, 106 KB)

Medication Policy and Formulary Updates 1st Quarter 2021

February 4, 2021 - View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 146 KB)