In this section, learn about our policies, requirements, criteria for evaluating and applying new technologies, and procedures that comprise our medical care solutions:
Review medical care solutions for Blue Shield Promise Cal MediConnect, Medi-Cal, or Medicare.
View the list of medical services and procedures requiring medical necessity review or supplemental documentation prior to payment.
Utilization management (UM) and clinical practice guidelines define healthcare standards applicable to members and providers.
Review drug formularies for Medicare, Medi-Cal and Cal MediConnect, and find pharmacy services information.
Find provider manuals, provider dispute resolution policies, medical record and access to care standards, and more.
Find common forms which you may need to request prior authorization, as well as patient referral forms.
