News and announcements

Sales tax reminder for Medi-Cal providers

October 20, 2021 - In accordance with Medi-Cal billing and reimbursement guidelines, since January 1, 2021, Blue Shield of California Promise Health Plan has been following the Medi-Cal guidelines regarding sales tax for incontinence, medical supplies, and durable medical equipment (DME). For your reference and convenience, we have excerpted relevant information below from the Medi-Cal Provider manuals in the attached document.
Read sales tax reminder (PDF, 88KB)

Postpartum Care HEDIS Tip Sheet

October 14, 2021 - L.A. Care has partnered with Blue Shield of California Promise Health Plan and other managed care plans to create a tip sheet to help providers improve their Healthcare Effectiveness Data and Information Set (HEDIS®) rates. The document lists best practices for ensuring timeliness of care and accurate documentation of postpartum services.
View Postpartum HEDIS Tip Sheet (PDF, 162KB)

Timeliness of Prenatal Care HEDIS Tip Sheet

October 14, 2021 - L.A. Care has partnered with Blue Shield of California Promise Health Plan and other managed care plans to create a tip sheet to help providers improve their Healthcare Effectiveness Data and Information Set (HEDIS®) rates. The document lists best practices for ensuring timeliness of care and accurate documentation of prenatal services.
View Prenatal HEDIS Tip Sheet (PDF, 193KB)

Recent enhancements to Provider Connection Claims section

October 12, 2021 - We’ve updated the Claims pages on the Provider Connection website to make it easier to find claims and view more of them at once. Log in and visit the Check claim status landing page to take a tour!
Go to Check claim status

New extended hours for Provider Information & Enrollment – 6 a.m. to 6:30 p.m.

October 4, 2021 - The Provider Information & Enrollment team for Blue Shield of California Promise Health Plan is now available to assist you between the hours of 6 a.m. and 6:30 p.m., Monday through Friday, at (800) 258-3091. After hours and during the weekend, our automated system will receive your calls and offer guidance. Please do not hesitate to reach out if you need assistance.

Formulary updates

September 27, 2021 - The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
See formulary changes

New revised claim submission process for incontinence and other medical supply products

July 20, 2021 - We are pleased to announce an update to Blue Shield of California Promise Health Plan systems which will enable providers to easily submit electronic claims and encounters for medically necessary incontinence products and other medical supply products for Medi-Cal and Cal MediConnect members, using Uniform Commercial Codes (UCCs) and other Product/Service ID codes, in addition to National Drug Codes (NDCs). This change is only applicable to professional (837P) services. For institutional (837I) claims and encounters, the 2410 loop will only accept the N4 National Drug Codes.
Read instructions (PDF, 89 KB)

How to download members’ ID cards

June 11, 2021 - Blue Shield of California providers can easily download members’ ID cards to access the information they need, saving time and reducing environmental waste. We’ve posted a 1-page resource on Provider Connection to show you how. (Login required.)
See instructions (PDF, 40KB)

Formulary Changes

June 8, 2021 - The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
See formulary changes

Medi-Cal DUR Articles & Alerts Update

June 4, 2021 - Medi-Cal Drug Utilization Review (DUR) articles and alerts were posted during the past few months by the Department of Health Care Services, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients.
View summary (PDF, 73 KB)

COVID-19 All Plan Letters Update – Additional revisions to APL 20-022

May 21, 2021 - The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. Recently, APL 20-022 was again revised to provide additional guidance. Read a summary of the APL revisions that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary (PDF, 88 KB)

Submit medical authorization requests using AuthAccel

May 11, 2021 - We are pleased to announce the launch of additional AuthAccel functionality for Blue Shield of California Promise Health Plan providers. Available 24/7 from Blue Shield’s Provider Connection website, the tool now includes the capability to submit medical authorization requests for both Medi-Cal and Cal MediConnect members, in addition to viewing the status of previous submissions.
Learn more about AuthAccel

Provider Connection Enhancements

April 14, 2021 - We are pleased to announce the latest enhancements to the Provider Connection website! Changes include improved web page design in several areas, and the ability for Account Managers to use the Provider Demographics page to update the practice information that appears in the Find a Doctor tool. Please check the revised Blue Shield Promise Provider Connection Reference Guide for information about these enhancements.
View guide (PDF, 1.6 MB)

COVID-19 All Plan Letters Update – Revisions to APL 20-004, APL 20-022

April 5, 2021 - The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. Recently, APL 20-004 and APL 20-022 were revised to provide additional guidance. Read a summary of the APL revisions that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary

Medi-Cal Bulletins Update

March 23, 2021 - Updates posted during February 2021 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary (PDF, 70 KB)

New extended hours for Provider Services – 6 a.m. to 6:30 p.m.

March 16, 2021 - The Provider Services team for Blue Shield of California Promise Health Plan is now available to assist you between the hours of 6 a.m. and 6:30 p.m., Monday through Friday, at (800) 468-9935. After hours and during the weekend, our automated system will receive your calls and offer guidance. Please do not hesitate to reach out to Provider Services if you need assistance.

Medi-Cal DUR Articles & Alerts Update

March 15, 2021 - Medi-Cal Drug Utilization Review (DUR) articles and alerts were posted during 2020 by the Department of Health Care Services, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients.
View summary (PDF, 78 KB)

Formulary Changes

February 23, 2021 - The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
See formulary changes

COVID-19 All Plan Letters Update – APL 20-021, APL 20-022

February 11, 2021 - The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. Recently, APL 20-021 and APL 20-022 were issued to provide additional guidance. Read a summary of the APLs that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary

Medi-Cal Bulletins Update

February 8, 2021 - Updates posted during January 2021 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary (PDF, 105 KB)

New Medi-Cal and APL web pages

January 27, 2021 - The Blue Shield of California Promise Health Plan provider website has been updated to include five new web pages that make it easy to find summaries and other information we want to share with you based on Department of Health Care Services (DHCS) Medi-Cal bulletins, All Plan Letters (APLs), and related Blue Shield Promise programs.
See links (PDF, 75 KB)

Department of Health Care Services All Plan Letter 20-016

January 25, 2021 - Read a summary of All Plan Letter 20-016 issued by the Department of Health Care Services (DHCS) entitled, “Blood Lead Screening of Young Children,” which may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary (PDF, 126 KB)

Visit the County of San Diego’s website for information on COVID-19 vaccines and more

January 22, 2021 - We are joining other healthcare organizations in San Diego County who are encouraging network providers and facilities to visit the county’s website for healthcare professionals. The website is for those who are serving in community and tribal health centers, hospitals, pharmacies, behavioral health settings, and dental clinics and provides information on enrolling as a COVID-19 vaccine provider, rollout phases, appointments, and more.
Visit the County of San Diego website

Medi-Cal Bulletins Update

January 19, 2021 - Updates posted during December 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary

Updates to provider website regarding pharmacy benefit management

January 19, 2021 - The Blue Shield of California Promise Health Plan provider website has been updated to reflect the following changes in pharmacy benefit management, effective January 1, 2021: 1) our Medicare contract has been transferred to Blue Shield of California; 2) pharmacy claims are now processed by CVS Health; and 3) a new page has been created on the Blue Shield Promise provider website for 2020 archived formulary changes.
See changes (PDF, 73 KB)

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Blue Shield of California Promise Health Plan has neither reviewed nor endorsed this information.

Blue Shield of California Promise Health Plan is an independent licensee of the Blue Shield Association. Blue Shield of California Promise Health Plan is a Medicare Advantage HMO plan with a Federal Government contract in California. Enrollment in Blue Shield of California Promise Health Plan depends on contract renewal.

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