2023-2024 News and announcements

Stay informed about programs, policies, and announcements issued in 2023-2024 by Blue Shield of California and Blue Shield of California Promise Health Plan.

Recent announcements for Blue Shield Promise providers

View latest announcements

Recent announcements for Blue Shield providers

LOINC codes needed for reporting depression screenings

April 22, 2024 – To meet HEQMS and HEDIS® standards, providers need to document depression screenings using LOINC® codes (Logical Observation Identifiers Names and Codes). While LOINC codes are not required for claims payment, not meeting these standards may negatively impact quality incentive payouts.
Read about depression screenings and LOINC codes (PDF, 487 KB)

Preferred Specialty Drug List for Medical Benefits Updated on January 1, 2024

December 31, 2023 – View a summary of the updated Preferred Specialty Drug List for medical benefits, effective January 1, 2024.
View list (PDF, 60 KB)
 

Specialists and facilities: Please share reports promptly with PCPs

December 1, 2023 – All specialty providers and facility administrators should promptly deliver consultation reports and facility discharge reports to their patients’ primary care provider (PCP) to support coordination of care.
Review notice (PDF, 93 KB)
 

New online dispute functionality

November 17, 2023 – You can now file disputes online for Blue Shield Medicare and Blue Shield Promise Medi-Cal claims. We’ve also revised the process for submitting bulk disputes. We now ask you to organize bulk dispute submissions by plan type – such as commercial, Medicare, or Medi-Cal.
See what's new
 

Medication policy and formulary updates 4th quarter 2023

November 2, 2023 – View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 1.2 MB)
 

ASPN Pharmacies triage services available for home infusion, beginning October 1, 2023

October 12, 2023 – Blue Shield of California has teamed up with ASPN Pharmacies (ASPN) to offer enhanced services and simpler processes for eligible HMO and PPO commercial plan members to arrange for home infusion services. Providers may now place orders with ASPN and they will work directly with members to find access to local home infusion providers.
Read frequently asked questions (PDF, 157 KB)
 

Cultural awareness and linguistics resources available

October 6, 2023 – Blue Shield has developed cultural awareness and linguistics reference materials to help our providers give the highest level of quality care and services to our shared members. These resources include free cultural competency training with CEU credits, demographics and language services information, translation services, and translated materials.
Access resources (PDF, 881 KB)
 

Provider Directory enhancement: Indicate that a provider offers gender affirming care

September 19, 2023 – We have recently updated the Blue Shield of California provider directory to enable you to indicate if a provider or organization offers gender affirming care services. This will allow members to use the Find a Doctor tool to connect with providers who offer these services. Please note that this identification should only be used for providers of specific gender affirming care services.
Read about the enhancement (PDF, 195 KB)
 

COVID 19 benefits policy

September 12, 2023 – Blue Shield of California has published a benefits policy regarding COVID-19 testing, therapeutics and related services, effective September 27, 2023, in accordance with California Health and Safety Code sections 1342.2 and 1342.3.
Review this COVID-19 benefit policy (PDF, 1.2 MB)
 

Medication policy and formulary updates 3rd quarter 2023

August 8, 2023 – View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 1.2 MB)
 

New forms available for radiation oncology prior authorization and post-service requests

June 30, 2023 – To help simplify the process of requesting authorization for radiation oncology services, Blue Shield of California has created two forms that may be faxed to us. One form may be used to request prior authorization and the other form may be used for post-service claims. Please note that use of these forms is NOT mandatory. We provide them to make it easier for you to submit requests and to help make sure that we receive all the information and documentation that is required to process claims.
See how to access the forms (PDF, 180 KB)
 

Medication policy and formulary updates 2nd quarter 2023

May 4, 2023 – View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 1.4 MB)
 

Preferred Specialty drug list for Medical Benefits updated on March 1, 2023

April 10, 2023 – View a summary of the updated Preferred Specialty Drug List for medical benefits, effective March 1, 2023.
View list (PDF, 29 KB)
 

How Senate Bill 1419 affects access to patient records and the sharing of test results

April 7, 2023 – Read a summary of California Senate Bill 1419 requirements for managing access to patient records and sharing test results. While some items in the bill are already part of existing privacy mandates, others may require changes to your current practices.
Read the summary (PDF, 248 KB)
 

ASPN Pharmacies added to Blue Shield of California’s Drop Ship Program, April 1, 2023

April 4, 2023 – We are pleased to announce that on April 1, 2023, ASPN Pharmacies joined the Blue Shield of California Drop Ship Program. ASPN Pharmacies improves the provider experience in drug procurement by triaging and coordinating prescription fulfillment, with status updates available through the ASPN web portal.
Read frequently asked questions (PDF, 83 KB)
 

Genetics Medical Policy updates

March 9, 2023 – Blue Shield of California recently notified providers that we are working to clarify and simplify coverage of genetic tests. In the coming months we will be reorganizing, updating, and reformatting our genetic testing medical policies and making those policies easier to locate. We will continue to post updated versions of these policies throughout 2023. You can review genetic testing medical policies on our Provider Connection website www.blueshieldca.com/provider.
Review notice (PDF, 44 KB)
 

Home Infusion benefit change lowers cost for eligible medication infusion therapy services for Blue Shield commercial PPO plan members

February 10, 2023 – Blue Shield of California is supporting its mission to lower the cost of health care for members by improving home infusion benefits for commercial PPO plan members. Members with prescriptions for medication infusion therapy services in an outpatient hospital setting can receive their infusion at their home from a network home infusion provider at a $45 copay.
Read frequently asked questions (PDF, 82 KB)
 

Medication policy and formulary updates 1st quarter 2023

February 2, 2023 – View a summary of Pharmacy and Therapeutics Committee decisions on injectable medication policy updates and formulary changes.
View summary (PDF, 926 KB)