Provider manuals

Why you need the manuals


Our provider manuals specifically address Blue Shield of California Promise Health Plan's contractual and regulatory requirements and are an extension of our provider agreement with your practice or facility.

The provider manual contains the policies, procedures, reference information, and minimum care standards required of Blue Shield Promise providers.
 

Change notifications


 April 2024 Blue Shield Promise Medi-Cal Provider Manual Change Notification letter (PDF, 192 KB)     

 April 2024 Blue Shield Promise Nursing Facility Reference Guide Change Notification letter (PDF, 170 KB)     

  

Manuals by plan type


 April 2024 Blue Shield Promise Medi-Cal Provider Manual (PDF, 3.2 MB)  

 April 2024 Blue Shield Promise Nursing Facility Reference Guide (PDF, 188 KB)  


After reviewing the manuals, complete the Acknowledgment of Blue Shield Promise Provider Manual form (PDF, 313 KB) and return it to us by fax or email:
Fax: (323) 889-5418
Email: ProviderRelations@blueshieldca.com

Additional information


Although the provider manuals contain comprehensive summaries of Blue Shield Promise policies and procedures, additional protocols regarding plan administrative practices, full plan medical policies, and other detailed information are available to the provider upon request by calling the Blue Shield of California Promise Health Plan Provider Services Department:

 Phone: (800) 468-9935, 6:00 a.m. to 6:30 p.m., Monday through Friday.

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.

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.

Forms

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

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.

© 2002-2024. 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。

Translate


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

Apple and the Apple logo are trademarks of Apple Inc. App Store is a service mark of Apple Inc.

Google Play and the Google Play logo are trademarks of Google LLC.