Blue Shield Promise treatment authorization request forms

View and download Blue Shield Promise medical policy treatment authorization request (TAR) forms.

Treatment authorization request forms

Medical care solutions

Review medical care solutions for Blue Shield Promise plans.

View and search the list of all clinical policies and procedures

Prior authorization list

View the list of medical services and procedures requiring medical necessity review or supplemental documentation prior to payment.

View prior authorization list

Tips for submitting Medi-Cal claims

Learn about best practices for billing Medi-Cal claims.

See Medi-Cal claims tips

Provider Connection

Access network provider tools on Provider Connection website.

Access Provider Connection

Health Care Options: (844) 580-7272 [TTY: (800) 430-7077], Monday through Friday from 8 a.m. to 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].

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

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。

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

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