Policies, guidelines, standards and forms
In this section you will find these resources:
- Access to care standards
- All Plan Letter summaries
- Health assessment guidelines for Medi-Cal providers
- Healthcare fraud prevention guidelines
- Medical records documentation standards
- Medi-Cal bulletin summaries
- Nursing facilities reference guide
- Physicians' site review policy and procedures
- Provider dispute policies and procedures
- Provider manuals
Commonly requested forms for prior authorizations, coverage determination requests, referrals, screenings, enrollment for electronic claims submission and remittance advices, and more are also available here.
Review and download provider manuals for Cal MediConnect and Medi-Cal policies.
Access to care standards
Learn the guidelines Blue Shield of California Promise Health Plan uses to ensure our members have proper access to care.
Health assessment guidelines for Medi-Cal providers
Learn how to conduct health assessments, find age-appropriate patient questionnaires and forms, and related provider training materials.
Nursing Facilities Reference Guide
Learn about the requirements for Blue Shield Promise's provider network nursing facilities.
Physician’s facility site review policy and procedures
See policies for site accessibility, fire safety and prevention, non-medical emergency procedures, medical equipment maintenance, and staff qualification requirements.
Medical record documentation standards
Learn about the requirements and standards for Blue Shield Promise member medical records.
Provider dispute resolution policy and procedures
Communicate your questions and concerns to Blue Shield Promise and learn how to appeal or dispute a claim payment.
Fraud prevention guidelines
Learn how to report suspected healthcare fraud and find prevention tips and guidelines.
Find the forms you need for authorizations, referrals, service requests, EFT enrollment, and provider disputes.
Medi-Cal bulletin summaries
Review summaries of the latest bulletins posted by the Department of Health Care Services.
All Plan Letter summaries
See what guidelines and requirements have been posted in the latest Department of Health Care Services All Plan Letters (APLs).
Clinical policies, procedures and guidelines
Learn about our policies, procedures, and requirements for evaluating and applying new technologies, devices, and procedures for our Medical Care Solutions.
COVID-19 All Plan Letter updates
View summaries of guidelines and requirements posted in the latest All Plan Letters (APLs) related to the COVID-19 emergency.
Non-contract GEMT payments
Get details on payments for non-contracted ground emergency medical transport providers (GEMT) specified in All Plan Letter 20-004.
Proposition 56 supplemental payments
See how providers may qualify for additional payments allocated from Proposition 56 tax funds.
Access network provider tools on Provider Connection website.