The application of each Blue Shield of California Promise Health Plan (Blue Shield Promise) medical policy is subject to state guidelines, regulatory requirements, and/or specific benefits and limitations stated in the plan Evidence of Coverage (EOC).
The goals of each medical policy include:
- Ensuring safe and effective technologies
- Supporting an evidence-based approach to technology
- Providing current and pertinent information regarding technologies (devices and procedures for medical and behavioral health)
- Improving the quality of care and services provided through Blue Shield Promise
Use medical policy information to provide Blue Shield Promise plan members with the highest standard of evidence-based medical care that is safe and effective.
Pharmacy services and drug formularies
Medi-Cal pharmacy benefits are managed by Medi-Cal Rx, which is administered by the Department of Health Care Services (DHCS). Find more information under the Pharmacy services and drug formularies section
Medical policy index
Use this alphabetical index to find Blue Shield Promise medical policies and to review requirements and criteria for new technologies, devices and procedures.
Medical policy list
Read about monthly updates to Blue Shield of California medical policy.
View the list of medical services and procedures requiring medical necessity review or supplemental documentation prior to payment.
Find forms you may need to submit treatment authorization requests for Blue Shield Promise Medi-Cal members.
Utilization management (UM) and clinical practice guidelines define healthcare standards applicable to members and providers.
Review drug formularies for Cal MediConnect and find pharmacy services information.
Find common forms which you may need to request prior authorization, as well as patient referral forms.