December 11, 2020 - The Department of Health Care Services (DHCS) has announced that the implementation of Medi-Cal Rx, the new state-run pharmacy benefit program originally scheduled to launch on January 1, 2021, has been postponed until April 1, 2021. Until then, all current prescription drug service processes will remain unchanged, and managed care plans such as Blue Shield of California Promise Health Plan will continue to administer pharmacy benefits for their Medi-Cal members.
Access announcement (PDF, 93 KB)
December 9, 2020 - Blue Shield of California Promise Health Plan is currently making supplemental payments in accordance with the California Healthcare, Research and Prevention Tobacco Tax Act (Proposition 56). We have revised our summary of processes and requirements related to these Proposition 56 payments to include instructions for electronic funds transfer (EFT). We recommend signing up for EFT to receive payments faster and avoid mail delays.
View the Proposition 56 Provider Notification (PDF, 133 KB)
December 1, 2020 - Updates posted during November 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 (PDF, 72 KB)
November 30, 2020 - Community-Based Adult Services (CBAS) are a managed care benefit available to Medi-Cal and Cal MediConnect (Dual Eligible) patients. CBAS centers provide care to eligible seniors and adults with disabilities that want to remain living at home instead of going to a nursing facility. During the COVID-19 emergency, congregate services have been suspended. However, CBAS centers continue to provide home-based care to participants through Temporary Alternative Services. Providers are encouraged to promote CBAS with potentially eligible patients and their family members or caregivers.
View summary (PDF, 82 KB)
November 30, 2020 - The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal, Medicare, and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
See formulary changes
November 30, 2020 - To increase knowledge and awareness of cultural and linguistically appropriate services (CLAS), Blue Shield of California Promise Health Plan is sharing a free e-learning accredited program, entitled A Physician’s Practical Guide to Culturally Competent Care. This program provides Continuing Education Units (CEU) credits for physicians, physician assistants, nurse practitioners and any other direct service providers interested in learning about CLAS.
Access training information (PDF, 96 KB)
November 9, 2020 - Updates posted during October 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 (PDF, 75 KB)
October 30, 2020 - Effective for dates of service after January 1, 2019, for billing claims, Blue Shield Promise will follow the Medi-Cal Fee for Service Program’s phased approach to converting local codes to national codes. Claims submitted with a local code will be accepted as long as the Department of Health Care Services has not converted the local code to a national code.
Read notice (PDF, 67 KB)
October 30, 2020 - Effective January 1, 2021, Blue Shield of California and Blue Shield of California Promise Health Plan will transition from SS&C to CVS Health (CVSH) for pharmacy claim processing and related services for all lines of business. The transition to CVSH and enhanced data security will require each user to register with a personal login and password to access CALINX Rx data. Providers can continue to obtain CALINX Rx pharmacy claims data using the current SS&C process through January 31, 2021.
Read notice (PDF, 70 KB)
October 29, 2020 - We are pleased to announce the latest enhancements to the Provider Connection website! Changes include sitewide search capability, a new claim activity dashboard, pinned claims functionality, and account management filtering and sorting. Registered Billing Service Managers can now request additional Tax ID access online. Also, the Account Manager’s Responsibilities section is now a one-stop shop for all activities an Account Manager may do. Please check the revised Provider Connection Reference Guide for information about these enhancements.
View guide (PDF, 2.42 MB)
October 19, 2020 - 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 was revised to provide additional guidance. Read a summary of the revisions that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary (PDF, 83 KB)
October 19, 2020 - In accordance with Medi-Cal billing and reimbursement guidelines, effective November 1, 2020, Blue Shield of California Promise Health plan will require Medi-Cal surgical modifiers for Current Procedural Terminology (CPT) codes 10000-69999 to be included in claims submitted with dates of service on or after November 1, 2020. Claims submitted without the required modifiers will be denied.
Learn more about Medi-Cal modifiers (PDF, 104 KB)
October 18, 2020 - Effective January 1, 2021, Medi-Cal pharmacy benefits will be administered by the Department of Health Care Services’ (DHCS) new Medi-Cal Rx program. DHCS is offering web-based instructor-led or computer-based training about Medi-Cal Rx through a Learning Management System (LMS), called Saba. Registration is available on the Medi-Cal Rx website.
See training details (PDF, 77KB)
October 13, 2020 - Updates posted during September 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 (PDF, 74KB)
September 29, 2020 - Updates posted during August 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 (PDF, 71KB)
September 18, 2020 - Read a summary of All Plan Letter 20-012 issued by the Department of Health Care Services (DHCS) entitled, “Private Duty Nursing Case Management Responsibilities for Medi-Cal Eligible Members under the Age of 21,” which may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary (PDF, 78KB)
September 9, 2020 - Read a summary of All Plan Letter 20-010 issued by the Department of Health Care Services (DHCS) entitled, “Cost Avoidance and Post-Payment Recovery for Other Health Coverage,” which may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary (PDF, 278KB)
August 20, 2020 - 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. They have also added supplements to APLs posted during 2019 to support the pandemic. Read a summary of the supplements that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary (PDF, 78KB)
August 20, 2020 - The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal, Medicare, and Cal Medi-Connect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
See formulary changes
August 20, 2020 - General essential information related to quality programs that we send to our network participants annually to ensure awareness of resources.
Review annual summary (PDF, 61KB)
August 19, 2020 - The Department of Health Care Services (DHCS), California Department of Public Health, and Office of the California Surgeon General have issued a Suicide Prevention notice, which contains tools and resources available to support suicide prevention efforts with a focus on the COVID-19 pandemic. We are sharing this notice with you at their request and encourage you to apply the information to your practice, as appropriate.
Read notice (PDF, 90KB)
August 12, 2020 - Blue Shield of California Promise Health Plan (Blue Shield Promise) is currently making supplemental payments in accordance with the California Healthcare, Research and Prevention Tobacco Tax Act (Proposition 56). We have revised our summary of processes and requirements related to these Proposition 56 payments to include APL 20-014.
View the Proposition 56 Provider Notification (PDF, 126KB)
August 12, 2020 - Updates posted during July 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 (PDF, 70KB)
July 17, 2020 - During the month of June 2020, the Department of Health Care Services revised two All Plan Letters (APLs) related to the COVID-19 crisis. APL 20-004 and APL 20-011 were revised. Read a summary of the revisions that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary (PDF, 88KB)
July 15, 2020 - Updates posted during June 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 (PDF, 72KB)
June 25, 2020 - Blue Shield of California Promise Health Plan (Blue Shield Promise) is currently making supplemental payments in accordance with the California Healthcare, Research and Prevention Tobacco Tax Act (Proposition 56).
Specifically, within the next several weeks, if they meet qualifying requirements, providers may receive a supplemental payment and details regarding services rendered that are eligible under one or more of the relevant All Plan Letters issued by the Department of Health Care Services
We have provided a summary of our processes for managing payments, inquiries, grievances and disputes related to these Proposition 56 payments, in addition to screening requirements for APL 19-016 and APL 19-018.
View the Proposition 56 Supplemental Payment Notification (PDF, 117KB)
June 25, 2020 - Blue Shield of California is working closely with medical providers, local and regional stakeholders, and collaborating with technology firms to bring the best ideas and solutions to the market. Learn how this effort addresses long-standing access, equity, cost and quality issues that have been further exposed during the COVID-19 pandemic.
Learn how Blue Shield is transforming health care
June 17, 2020 - Read a summary of All Plan Letter 20-007 issued by the Department of Health Care Services (DHCS) to Community-Based Adult Services (CBAS) providers, which may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary (PDF, 104KB)
June 16, 2020 - Updates posted during May 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 (PDF, 66KB)
June 5, 2020 - The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal, Medicare, and Cal Medi-Connect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
See formulary changes
June 4, 2020 - Read a summary of the All Plan Letters (APLs) issued by the Department of Health Care Services (DHCS) in the past several weeks regarding COVID-19 that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View summary (162 KB)
May 26, 2020 - Updates posted during April 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 (72 KB)
April 23, 2020 - As part of an over $200 million commitment to support healthcare providers and hospitals facing financial pressures resulting from the coronavirus (COVID-19) pandemic, Blue Shield of California has announced four programs available to its network providers.
Learn more details now at Blue Shield’s news center.
April 22, 2020 - Medi-Cal Drug Utilization Review (DUR) articles and alerts were posted during Q4 2019 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 (70 KB)
April 22, 2020 - In compliance with the Centers for Medicare & Medicaid's final regulations on the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), Blue Shield Promise developed the Special Needs Plan (SNP) Model of Care for Medicare and Cal MediConnect members. If you are a provider who cares for these members, you are required to complete the annual Cal MediConnect and Dual Eligible Special Needs plan provider training. Click the link below to complete the course. You must click the attestation on the last slide to gain completion.
View the training (10 min)
April 21, 2020 - The latest version of Due Date Plus® is now available for download from the App Store® and Google Play™. We invite you to share this news with your patients in Los Angeles and San Diego counties who are expecting or are new parents.
Read about the app (78 KB)
April 8, 2020 - Updates posted during Q1 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 (85 KB)
April 1, 2020 - The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal, Medicare, and Cal Medi-Connect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
See formulary changes
March 31, 2020 - Updates posted during Q4 2019 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 (79 KB)
January 28, 2020 - Updates posted during 2019 by the Department of Health Care Services regarding important topics you need to know about when providing services to Blue Shield of California Promise Health Plan Medi-Cal members.
View summary (100 KB)
January 2, 2020 -
You may notice a different "look and feel" to the format of the website, including the section we previously called "Provider Resources."
We have redesigned the Provider Resources section to improve navigation. You will continue to find forms, updates, program information, medical and medication policies here, but more easily. This part of the website does not require logging in, so you can access these resources at any time. You will see that a new landing page in the Providers section will allow you to quickly link to specific resources that are used often.
As we continue to enhance our website resources, we hope you will find our new format helpful. We encourage you to check this section periodically for new announcements.
October 14, 2019 - Updates posted by the Department of Health Care Services regarding important topics you need to know about when providing services to Blue Shield of California Promise Health Plan Medi-Cal members.
Read summary (PDF, 84 KB)
October 4, 2019 - Network provider update regarding this All Plan Letter 19-010 issued by the Department of Health Care Services regarding requirements to provide early and periodic screening, treatment, diagnostic and treatment services (EPSDT) to eligible members under the age of 21.
View notice (PDF, 145 KB)
August 6, 2019 - General essential information related to quality programs that we send to our network participants annually to ensure awareness of resources.
Review annual summary (PDF, 86 KB)
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.