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
Health assessment guidelines for Medi-Cal providers
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.