Use this list to find Blue Shield of California Promise Health Plan payment policies applicable to claims for our Medi-Cal plan members. These policies are updated periodically.
When you click on one of the policy links below, it will direct you to the Provider Connection login page. You will need to log in to view and/or download the policy.
If you do not yet have an account on our Provider Connection website, follow these steps to establish an account:
- Visit www.blueshieldca.com/provider.
- On the home page, click “Login/Register” and follow the prompts to create an account.
Once you are registered and have an active account on Provider Connection, you will be able to click on any of the payment policies below, log in, and view and/or download that policy. You do not have to be contracted with Blue Shield of California to establish an account on the Provider Connection website, but you must meet the requirements to be approved for a provider account on the website.
PI0060 Inpatient Readmissions (PDF, 159 KB)
PI0061 Psychotherapy Add-On with High Level E/M (PDF, 135 KB)
PI0062 Hospice Services - Network Participation Requirements (PDF, 105 KB)
View the list of medical services and procedures requiring medical necessity review or supplemental documentation prior to payment.
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.
Our Disease Management Program provides education, care coordination, and support for members with certain chronic conditions.
Find common forms which you may need to request prior authorization, as well as patient referral forms.