Recognizing the strong relationship between the health of parents and the health of their infants, the Maternity Program is a comprehensive care management program designed to support Blue Shield of California Promise Health Plan members and their partners before, during, and after pregnancy with a goal of improved health outcomes for parents and their infants.
What to expect when you are referring your patients to the Blue Shield Promise Maternity Program.
The Maternity Program care team is composed of dedicated nurses, social workers, and care coordinators. Members will be contacted within two business days after receiving the referral and then as needed throughout the duration of the pregnancy until they have reached three months postpartum.
How to refer an eligible Blue Shield Promise member to the Maternity Program.
Fax a completed Maternity Program referral form (PDF, 326 KB) to (844) 893-1211 or call (888) 802-4410
When submitting the referral form, please include the following if available:
- Comprehensive Risk Assessment Tools (CRAT)
- Intimate Partner Violence (IPV) Screening
- Adverse Childhood Experience Questionnaire (ACE)
- Birthing Checklist
The program is completely confidential and is available to members at no extra cost.
Your office may be contacted for any care coordination needs.
How the Maternity Program increases access to providers, resources, and services
- Addresses racial disparities in access and outcomes
- Improves maternal and infant clinical health outcomes
- Improve quality of care as demonstrated through Centers for Medicare & Medicaid Core, HEDIS®, and other clinical priorities
- Reduces the costs associated with high-risk pregnancies by improving clinical outcomes
HEDIS is a registered trademark of the National Committee for Quality Assurance.
Maternity Program support and resources for members
- Support and education to help members manage their personal health needs during the perinatal period
- Connection to community resources for members who are pregnant and who have recently delivered
- Care management for members experiencing a high-risk pregnancy
- Resources for members who may be experiencing a pregnancy loss
- Guidance in managing decisions around pregnancy and family planning
Women, Infants, and Children (WIC); formula; and nutritional products
Providers are required to assess pregnant and postpartum members, infants, and children for nutrition-related needs and potential eligibility for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Offer a referral when appropriate and coordinate WIC services with the member’s care plan.
WIC provider referrals: California WIC resources for health care providers
Formula and nutritional products
Determine whether the member needs a standard WIC contract formula or a medically necessary formula or enteral nutritional product. WIC provides standard contract formula as a food benefit. For members enrolled in Medi-Cal, medically necessary formulas and nutritionals should be requested through Medi-Cal Rx first.
For Members enrolled in Medi-Cal
- Confirm that the product is included on the Medi-Cal Rx List of Contracted Enteral Nutrition Products and review any product-specific requirements.
- Submit a complete written or electronic prescription. Include the diagnosis, product name and 11-digit billing number, dose or daily quantity, route of administration, length of therapy, and clinical justification.
- Submit prior authorization when required through an approved Medi-Cal Rx submission method. Include supporting records, such as relevant chart notes or laboratory results, when needed.
- Direct the member or caregiver to take the prescription to a Medi-Cal pharmacy.
Medi-Cal Rx prior authorization forms and resources
Medi-Cal Rx Prior Authorization Request (PDF, 781 KB)
When to refer to WIC for formula or nutritionals
Refer the member to the local WIC office when the member does not have Medi-Cal coverage or the prescribed product is not covered by Medi-Cal. Submit complete medical documentation using the current WIC Medical Formula and Nutritionals Request Form. WIC reviews requests for qualifying medical conditions and may provide an approved product through the WIC Card or a special-order process, subject to program requirements and availability.
WIC Medical Formula and Nutritionals Request Form
WIC Medical Formula and Nutritionals Request Form (PDF, 359 KB)
Doula services
What is the Medi-Cal doula benefit?
Blue Shield Promise doula services are a covered Medi-Cal benefit designed to improve access to pregnancy care and promote healthy outcomes for parents and babies. Doulas provide non-medical support throughout the perinatal journey, helping members feel informed, supported, and empowered to make decisions about their care.
The doula’s role and services
Doula services may include education, advocacy, and emotional and physical support throughout pregnancy, labor, birth, and the postpartum period. Doulas can serve as advocates for patient autonomy, social support, emotional support, and as maternal and infant educators. Doulas may assist with:
- Health navigation
- Birth plan development
- Evidence-based education
- Lactation support
- Connections to community resources
Doulas are trained birth workers who provide non-medical care before, during, and after pregnancy. They may also provide compassionate support during and after miscarriage, stillbirth, and abortion.
Doulas are not licensed healthcare providers. They do not diagnose medical conditions, provide medical advice, or perform clinical assessments, examinations, or procedures.
For providers recommending doulas
Find a Blue Shield Promise plan doula on the Blue Shield's Find a Doctor's website
Questions and answers about doula services – for recommending providers (PDF, 456 KB)
Doula Frequently Asked Questions (from the Department of Health Services
Is your relationship affecting your health? (PDF, 820 KB)
Office of the California Surgeon General: Preconception Medical Assessment (PreMA)
Guides and training for doulas
Blue Shield Promise Doula Resource Guide (PDF, 4.7 MB)
Caring for Families, Birth, and Beyond video about intimate partner violence (59 min)
Caring for Families, Birth and Beyond (PDF, 1.7 MB)
Questions and answers about doula services – for doulas (PDF, 619 KB)
Reporting forms for doulas
Doula Visit Detail Log (PDF, 449 KB)
How to complete and submit the Doula Visit Detail Log (PDF, 528 KB)
Blue Shield of California Promise Birth Outcome Report (PDF, 395 KB)
How to refer a Medi-Cal member for doula services
The Department of Health Care Services (DHCS) issued a statewide standing recommendation that all Medi-Cal members who are pregnant or were pregnant within the past year would benefit from receiving doula services from a Medi-Cal-enrolled doula provider. The recommendation fulfills the federal requirement for a physician or other licensed practitioner of the healing arts acting within their scope of practice to provide a written recommendation for preventive services.
With the statewide recommendation, an eligible Medi-Cal member may access the following doula services:
- One initial 90-minute visit with a doula
- Up to eight additional visits in any combination of prenatal and postpartum visits.
- Support during labor and delivery (including labor and delivery resulting in a stillbirth), abortion or miscarriage
- Up to two three-hour postpartum visits after the end of pregnancy
- If the member did not have a doula while pregnant, they may us ethe initial visit and all eight visits during the postpartum period.
The first provider recommendation may be offered by the following methods:
- Written recommendation in the member’s record
- Standing DHCS recommendation for doula services by a managed care plan, physician group, or another group by a licensed provider.
- Recommendation form signed by an authorized provider that a member can provide to a doula
- Referral to the Blue Shield Promise Maternity Care Management program, indicating recommendation for doula services
Members can also get doula services for up to 12 months after the end of their pregnancy. They can call their providers or the Maternity Care Management team if they need more doula visits. Up to nine additional postpartum visits are available with an additional recommendation from a physician or other licensed practitioner of the healing arts.
How to recommend Blue Shield Promise members for doula services
To recommend Blue Shield Promise members for doula services:
Fax the completed Maternity Program referral form (PDF, 326 KB) to (844) 893-1211.
Email the completed Maternity Program referral form (PDF, 326 KB) to BSCPromiseDoula@blueshieldca.com.
For more information, call (888) 802-4410 (TTY: 711).
Related programs
Maternal Mental Health
The Maternity Program has specialized social workers on the team to provide support. We can also refer members to other behavioral health specialists.
We provide access to specialists who can offer help and guidance with the services listed below:
- Stress management
- Management of depression and anxiety
- Addressing Adverse Childhood Experiences (ACEs)
- Other behavioral health conditions
Blue Shield Promise also offers guidance for helping providers to comply with California’s mandate (Assembly Bill 2193) that requires perinatal patients to be screened for depression. Visit the Maternal Mental Health page for more information on the requirement, the approved and recommended depression screening tools, resources and next steps for perinatal members whose screening results are positive for depression.
The Promising Start Program for San Diego County members
Promising Start is a Blue Shield Promise program that offers extra help for new parents and babies at no cost. Eligible members get a starter kit, help with checkups, and Amazon.com vouchers for baby supplies.
How it works:
1. The member calls Blue Shield Promise Customer Service and asks to join the Promising Start program.
2. Once enrolled in the program, members can get a Promising Start Kit diapers, baby wipes, and other helpful items.
Promising Start Kit eligibility criteria:
- Enrollment in a Blue Shield Promise health plan
- Reside in San Diego County
- Pregnant or have a baby no older than 12 months of age
Current pick-up location:*
Chicago Federation of San Diego County Barrio Station
2175 Newton Ave.
San Diego, CA 92113
Open Wednesdays from 9 a.m. to 5 p.m. PT
*Pick up locations are subject to change.
3. After the member attends the recommended postpartum and well-child visits and notifies Blue Shield Promise Member Services, Amazon.com will send the family a $100 gift voucher that may be used to get diapers and other essentials from the Promising Start catalog. The family can qualify for up to four $100 Amazon.com vouchers after reaching the required care milestones. Both the birthing parent and the baby must be enrolled with Blue Shield Promise to receive the Amazon vouchers.
Maternal compliance and oversight
Blue Shield Promise needs your assistance in helping our members get optimal perinatal care and the best possible pregnancy outcomes. In addition, we must maintain compliance with the (DHCS) Policy Letter (PL) 12-003 - Obstetrical Care – Perinatal Services.
Blue Shield Promise is required to ensure that our network providers are following Comprehensive Perinatal Services Program (CPSP) or American College of Obstetricians and Gynecologists (ACOG) practice guidelines. Blue Shield Promise nurses conduct site visits and medical record reviews of randomly-selected providers to monitor compliance with this requirement, using the DHCS Medical Record Review Tool.
Please notify us via email at CPSPMonitoring@blueshieldca.com if requests for the site visits are to be sent to a specific contact, centralized location, or if access to your electronic medical record (EMR) system is available.
The Medical Record Review Tool will be included with medical record requests and is available upon request. Once we have completed our medical record review, we will share your results with you. Providers must achieve a score of 80% or higher to receive a passing score. Any score lower than 80% or noted trending deficiencies may require a Corrective Action Plan (CAP). In the event a CAP is required, Blue Shield Promise will provide additional training and resources as needed.
We thank you for responding promptly to our requests for medical records and completing CAPs in a timely manner.
Our Med-Cal Provider Incentive Program provides incentives for network physician practices and independent physician associations (IPAs) to support and encourage high standards in health care for our valued Medi-Cal plan members.
Our Complex Case Management program allows us to work directly with members and collaborate closely with their physicians to coordinate care and services to high-risk members.
Blue Shield Promise has developed the Transitional Care Management Program to deliver high-quality care to our members during care transitions. This program meets all regulatory requirements.
Blue Shield Promise supports members and their partners before, during and after pregnancy to help improve outcomes for parents and infants.
Blue Shield Promise behavioral health services cover mental health, substance use disorder, and autism spectrum disorder behavioral health treatment.
Our Disease Management Program provides education, care coordination, and support for members with certain chronic conditions.
Learn about mental health resources for network practitioners who are providing prenatal or postpartum care.
Blue Shield Promise created a Quality Improvement Program (QIP) for all lines of business. This program allows us to identify opportunities for improvement of care and services to our members and providers.
Blue Shield Promise assists you in meeting health education state requirements by providing appropriate health education materials for you to distribute to your patients. These multilingual materials are available in the state-mandated topics.
Blue Shield Promise ensures that all our members have access to translation services that help them access programs and care in their language of choice.