Provider disputes and resolution policy and procedures

Provider questions, concerns, and disputes

Providers can voice questions and concerns to the Blue Shield of California Promise Health Plan Provider Services Department by calling, mailing a letter, sending an email, or visiting in person. A provider network administrator can address many of these questions and concerns very quickly.

Providers who are submitting corrected claims that the Blue Shield Promise Claims Department requested should submit the corrected claims directly to the claims department, with a reference to the Remittance Advice Notice received. 

Providers who are submitting claims for retroactive review (review after the services have been provided) should submit the claims directly to the claims department and not to the Provider Dispute and Resolution Department. If the Claims Department requested that you send medical records, please submit your response to the claims department and not to the Provider Dispute and Resolution Department. 

If a provider would like to appeal or dispute a claim payment, the provider must submit it in writing by mail to the Blue Shield Promise Provider Dispute and Resolution Department. If a provider attempts to file a dispute by phone, Blue Shield Promise will assist the provider in filing the dispute in writing by physical or electronic means.  All appeals and disputes are entered in the Provider Dispute Database for investigation, and providers will receive a written response.

Provider Dispute Resolution Request Form (PDF, 358 KB)

Medi-Cal provider dispute and resolution policy and procedures

Learn how to file an appeal or dispute as a Medi-Cal provider.

Forms

Find the forms you need for authorizations, referrals, service requests, EFT enrollment, and provider disputes.

Provider Connection

Access network provider tools on Provider Connection website.

Health Care Options: (844) 580-7272  {TTY: {800) 430-7077}, Monday through Friday from 8 a.m. — 6 p.m. 

For information on Blue Shield Promise plans for your health care, call the Department of Health Care Services at (800) 430-4263 {TTY: (800) 735-2922}, or visit https://www.healthcareoptions.dhcs.ca.gov/.

Blue Shield of California Promise Health Plan is a managed care organization, wholly owned by Blue Shield of California, offering Medi-Cal Plans.

© 2002-2023. California Physicians’ Service DBA Blue Shield of California Promise Health Plan. All rights reserved.

California Physicians’ Service DBA Blue Shield of California Promise Health Plan is an independent licensee of the Blue Shield Association.

The provider network may change at any time. You will receive notice when necessary.

Blue Shield of California Promise Health Plan complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.

Blue Shield of California Promise Health Plan cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascedencial, religión, sexo, estado civil, genero, identidad de genero, orientación sexual, edad ni discapacidad.

Blue Shield of California Promise Health Plan 遵循適用的州法律和聯邦公民權利法律,並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻 狀況、性別認同、性取向、年齡或殘障為由而進行歧視。

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Blue Shield of California Promise Health Plan, 3840 Kilroy Airport Way, 
Long Beach, CA  90806

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