June 2, 2022 - Have you heard about the Due Date Plus app, available for download from the App Store and Google Play? We invite you to share information about the app with members in Los Angeles and San Diego counties who are new parents.
Read about the app (PDF, 334 KB)
June 1, 2022 - Medi-Cal Drug Utilization Review (DUR) articles 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, 83 KB)
May 10, 2022 - Blue Shield of California Promise Health Plan recently reminded directly contracted providers in the primary care specialties that they need no prior authorization to refer Blue Shield Promise Medi-Cal members to network specialists for consultations.
Following a consultation, if specialty treatment is recommended, it is necessary to check Blue Shield Promise’s prior authorization list, available on this website, to determine whether a prior authorization is needed for covered treatment.
Review notice (PDF, 31 KB)
December 7, 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
December 6, 2021 - When CMC sunsets at the end of 2022, Blue Shield Promise members will be transferred to D-SNPs. View this recorded webinar to learn more.
Recorded webinar (25 min)
November 16, 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, 76 KB)
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)
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)
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)
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
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.
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
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)
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)
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
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)
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)
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
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)
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
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)
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.
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)
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
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
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)
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)
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)
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
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
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)
Find copies of provider communications issued prior to 2021.
Sign up for upcoming webinars about working with Blue Shield Promise and our members.
Stay informed of updates and resources that support our new infrastructure since January 1, 2019.
Review summaries of the latest bulletins posted by the Department of Health Care Services.
See what guidelines and requirements have been posted in the latest Department of Health Care Services All Plan Letters (APLs).
Access network provider tools on Provider Connection website.