Are the Blue Shield Promise Health Plan and Blue Shield of California provider networks combined?
No, all the Blue Shield Promise contracted networks of primary care physicians (PCPs), specialists, and hospitals remain separate after January 1, 2019. Members will not have access to see Blue Shield Promise providers unless those providers are directly contracted with Blue Shield Promise.
Do Blue Shield Promise providers need to contract with Blue Shield of California?
No, they do NOT need to contract with Blue Shield of California to continue providing services for Blue Shield Promise Medicare Advantage HMO members. Providers previously participating in the Care1st network have received an amendment notice reflecting the name change.
Can members continue to see their primary care physician (PCP) and/or specialists previously contracted with Care1st?
Yes, members can continue to see their PCP and specialists as participating providers. All the Care1st contracted networks, including hospitals, are available to our members through Blue Shield Promise.
Why did Blue Shield Promise migrate provider and member data?
On January 1, 2019, the newly renamed Blue Shield of California Promise Health Plan moved member and provider data into Blue Shield of California’s systems as part of our infrastructure improvements to better support our members and providers.
What were some of the key changes that network physicians and provider organizations experienced because of the data migration?
Key changes include:
- New provider identification numbers
- New member identification numbers
- New member ID cards
- Changes to submission processes for encounter data
Why did providers receive a new trading partner agreement from Blue Shield of California Promise Health Plan for electronic remittance advices (ERAs)?
Providers received a new agreement from trading partners because they have been identified by the trading partner as participating in Blue Shield of California Promise Heath Plan’s network. The trading partners already had an agreement in place with Blue Shield of California for ERAs. Due to the data migration on January 1, 2019, Blue Shield Promise was added as lines of business to the existing trading partners’ agreement with Blue Shield of California. Providers are required to sign and return the existing agreement to Blue Shield of California.
Will providers receive combined ERAs for Blue Shield of California and Blue Shield Promise after January 1, 2019?
No, providers will continue to receive separate ERAs for Blue Shield of California and Blue Shield of California Promise Health Plan after January 1, 2019. Providers can either continue to receive remittances from Office Ally as they do today, or they can choose the clearinghouse they are currently using for Blue Shield of California. The option they choose will apply to both Blue Shield of California and Blue Shield of California Promise Health Plan.
Can a provider choose a different ERA?
No, a provider must either continue to receive ERAs from Office Ally as they do today, or they can choose the clearinghouse they are currently using for Blue Shield of California. The option they choose will apply to both Blue Shield of California and Blue Shield of California Promise Health Plan.
Is there a dedicated claims unit that handles Medi-Cal?
Yes. Although we migrated systems, our claims processing units are intact and remain the same as they were before the migration. Blue Shield Promise providers can continue to contact our existing claims-processing staff.
Can providers see the status of these claims on Provider Connection?
No. Blue Shield of California Promise Health Plan membership, eligibility, and claims are not accessible from Provider Connection. You can view claims and verify membership and eligibility on the Blue Shield Promise Provider portal. If a provider is contracted with both Blue Shield of California and Blue Shield of California Promise Health Plan, they will need to access separate portals.
Is there training for contracted providers?
Although there is no formal training required, contracted providers can expect to receive ongoing communication about any necessary changes resulting from data migration and related impacts.
Whom should providers contact for more information on the name change or the data migration?
They can send an email to Provider_Relations@blueshieldca.com.
What is the current telephone number for providers to call with questions?
Our phone number is (800) 468-9935. The menu options allow providers to choose the department they need to reach. See our Blue Shield Promise quick phone reference guide (PDF, 129 KB)