This page contains educational resources such as FAQs, recorded webinars, eLearning modules, and "how to" guides to help you work with Blue Shield of California and Blue Shield of California Promise Health Plan effectively and efficiently.

Tutorial topics:
Blue Shield products, plans and networks
Claims and billing
Provider data management
Treatment cost estimator for Blue Shield PPO members

Blue Shield products, plans and networks

Blue Shield plans and networks

This is a list of plan and network names for Blue Shield of California 2022 HMO, PPO, POS, and EPO products.
2022 Blue Shield benefit plans and networks (PDF, 100 KB)

Blue Shield of California Tandem PPO Network

Learn about the difference between the Full PPO and Tandem PPO Networks, how to update your provider demographic information, and how to ensure Tandem PPO member claims are processed as In-Network.
Resource Guide (PDF, 1.3 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

2021 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)

2021 Blue High Performance Network

The Blue High Performance NetworkSM (Blue HPNSM) is a new Blue Cross and Blue Shield national high-performance network that launched January 1, 2021. This FAQ will help Blue Shield providers participating in Blue HPN understand the network. 
Frequently Asked Questions (PDF, 120 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)

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

Authorizations, Claims and Billing for Skilled Nursing Facilities

This webinar provides Blue Shield Promise Health Plan Skilled Nursing Facilities with information and resources to help efficiently and accurately submit authorizations and claims. Speakers also covered provider dispute resolution and corporate recovery.
Recorded webinar (42 min)
Presentation (PDF, 1.3 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

Encounter data for Blue Shield Promise providers – June 2021

Find out how you and your staff can improve the quality of encounter data submissions. Topics include updates on data submission challenges and solutions, Provider Connection enhancements, and billing reminders.
Recorded webinar (22 min)
Presentation (PDF, 1.5 MB)

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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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, 283 KB)

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, 23 KB)

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Treatment Cost Estimator for Blue Shield PPO members

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.

Provider Data Review

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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