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 for Blue Shield providers
Treatment cost estimator for Blue Shield PPO members

Blue Shield products, plans and networks

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 launching January 1, 2021. The materials below will help Blue Shield providers participating in Blue HPN to provide health care services to Blue HPN members. 
Recorded Webinar (1 hour)
Presentation (PDF, 1 MB)
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)

Blue Shield plans and networks

This is a list of plan names (with networks) for Blue Shield of California 2021 HMO, PPO, POS, and EPO products.
2021 Blue Shield benefit plans and networks (PDF, 78 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)

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Claims and billing

Provider encounter data for Blue Shield Promise providers – March 2021

View the latest quarterly Blue Shield Promise Provider Encounter Data webinar designed to help you and your staff Improve the quality of encounter data submissions. Topics include Provider Connection updates, data submission challenges and solutions, and billing reminders.
Recorded webinar (45 min)
Presentation (PDF, 1.7 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 for Blue Shield providers

Provider Validation Spreadsheet

To ensure that your demographic information is accurate and to meet SB-137 requirements, you must complete and return a Provider Validation Spreadsheet once per year. These tools will tell and show you exactly what to do.
Provider Validation Spreadsheet Instructions (PDF, 249 KB)

IPA Validation Roster Process Update Webinar

The materials below will help you update the Blue Shield IPA Validation Roster for your organization.
Presentation (PDF, 915 KB)
IPA Validation Roster Update Process Instructions (PDF, 839 KB)
IPA Validation Roster Update Process FAQs (PDF, 181 KB)

Individual Tab Demonstrations: IPA Validation Roster Spreadsheet

View these short WebEx demos provided for tabs that are more complex and/or have new fields.
Tab 1: PRAC IPA WebEx demo (4 min)
Tab 2: PRAC IPA Role WebEx demo (4 min)
Tab 7: PRAC Hospital WebEx demo (1 min)

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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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