News and announcements

New Physician Certification Statement form for requesting NEMT for members

January 30, 2024 – Blue Shield of California Promise Health Plan is pleased to announce an updated Physician Certification Statement (PCS) form for physicians to use when requesting non-emergency medical transportation (NEMT) for Blue Shield Promise members with Medi-Cal health coverage. We have updated this form to clarify the providers permitted to authorize NEMT.

Download the new form

California Electronic Visit Verification (CalEVV) codes update

January 17, 2024 – Effective January 1, 2024, the California Electronic Visit Verification (CalEVV) team implemented several changes, which are summarized in the announcement linked below. Please be sure to use EVV for all home-based encounters.

Read the announcement

GED benefit available for members aged 18 and older

January 16, 2024 – Members aged 18 years and older can get free help preparing for and taking the General Education Development (GED) test through the GEDWorks™ program. Please share this flyer with your patients.

Download the flyer

AB 1241 telehealth policy clarification

January 9, 2024 – California Assembly Bill 1241 (AB 1241) says that if a patient requests services be provided in person instead of via telehealth and their provider cannot accommodate them, the provider should arrange for a referral to a provider who can provide in-person care. A recent update clarifies that the provider is not required to schedule an appointment with a different provider on behalf of the patient.

Read AB 1241 


 

December 7 – Enhanced Care Management and Community Supports Townhall

December 7, 2023 – L.A. Care is sponsoring a townhall webinar for L.A. County providers on Thursday, December 7, 2023, at 10:00 a.m. The topic is “Enhanced Care Management and Community Supports.” 

Learn more and register for the webinar (PDF, 128 KB)

Billing reminder – Entering correct National Drug Codes for physician-administered drugs

December 1, 2023 – Blue Shield of California Promise Health Plan requires providers to bill physician-administered drugs (PADs) using National Drug Codes (NDC) according to Medi-Cal guidelines that accurate claim information is required for drug reimbursement. 

Read guidelines (PDF, 230 KB)

New online dispute functionality

November 28, 2023 – You can now file disputes online for Blue Shield Promise Medi-Cal claims. The new functionality includes the ability to submit bulk disputes for multiple claims.

See what's new

Subacute Care Facilities – DHCS SCU contract applications due December 15, 2023

November 16, 2023 – Effective January 1, 2024, Medi-Cal managed care plans in all counties must ensure that members in need of adult or pediatric subacute care services are placed in a healthcare facility that is under contract for subacute care with the California Department of Health Care Services (DHCS) Subacute Contracting Unit (SCU) or is actively in the process of applying for a contract with SCU. To receive Medi-Cal reimbursement, facilities must have a Subacute Care Program contract with DHCS SCU. Facilities must submit an application to SCU by December 15, 2023.

Read the Subacute Contracting fact sheet

New postal address for provider dispute resolution requests

October 13, 2023 – Blue Shield of California Promise Health Plan has a new postal address for provider dispute resolution requests that need to be submitted in writing: FirstSource – PHP PDR, 265 Airpark Blvd Ste 100, Chico, CA 95973. Please remember to include a completed Provider Dispute Resolution Request form with your mailings.

See the form (PDF, 392 KB)

Equity and Practice Transformation (EPT) Payment Program

October 13, 2023 – The Department of Health Care Services is implementing a one-time $700 million primary care provider practice transformation program to advance health equity and reduce COVID-19-driven care disparities. Find out if your provider organization qualifies for directed payments. Applications are due to DHCS on October 23, 2023, at 11:59 p.m.

Read the program description (PDF, 405 KB)

Provider Directory enhancement: Indicate that a provider offers gender affirming care

September 19, 2023 – We have recently updated the Blue Shield of California Promise Health Plan provider directory to enable you to indicate if a provider or organization offers gender affirming care services. This will allow members to use the Find a Doctor tool to connect with providers who offer these services. Please note that this identification should only be used for providers of specific gender affirming care services.

Read about the enhancement (PDF, 204 KB)

Health education materials and video library

June 30, 2023 – We are pleased to announce that we have a new health education materials and video library! Materials are available in English and Spanish. You may print materials as needed for Blue Shield of California Promise Health Plan members. Printed copies of materials or materials in other languages or alternative formats are also available.

Access the library

Use of filter paper should be discontinued for blood lead screening

June 12, 2023 – Per advisement from the California Department of Public Health Childhood Lead Poisoning Prevention Branch, use of filter paper testing should be discontinued for blood lead tests due to well-documented issues of possible contamination.

Read filter paper update (PDF, 232 KB) 

New Blue Shield of California Promise Health Plan Medi-Cal Quality Improvement Bulletin

May 11, 2023 – Blue Shield of California Promise Health Plan now offers a periodic Medi-Cal Quality Improvement Bulletin to provide current information about the programs we offer in collaboration with our network healthcare providers, with the goal of providing our Medi-Cal members with access to quality care. Topics will range from information on events, how Blue Shield Promise rewards practices through provider incentive programs, details about related opportunities for clinical interventions, and more.

Review Quality Improvement Bulletin

End of COVID-19 public health emergency

May 11, 2023 – The COVID-19 national public health emergency expired on May 11, 2023. While some temporary waivers and flexibilities ended, other policies have been continued to meet ongoing patient needs. Please visit our COVID-19 APL Updates page for the most recent changes to Medi-Cal requirements for managed care plans.

Go to COVID-19 APL Updates

Healthy Rewards Program incentivizes Medi-Cal members to take care of their health 

May 10, 2023 – Blue Shield of California Promise Health Plan offers an innovative Healthy Rewards Program to help improve the quality of care of our Medi-Cal plan members by rewarding them for completing preventive screenings.  

When a Blue Shield Promise Medi-Cal plan member completes a health care activity by December 31, 2023, and notifies us it is complete, we will send them a reward of their choice from the options available. The more activities they complete, the more they will earn.  

Please direct Blue Shield Promise Medi-Cal members with questions to call Icario at (866) 549-4627, TTY 711. Representatives at the Icario call center are available from 5 a.m. to 7 p.m., Monday through Friday and 7 a.m. to 12 p.m., on Saturday. 

How Senate Bill 1419 affects access to patient records and the sharing of test results

April 6, 2023 – Read a summary of California Senate Bill 1419 requirements for managing access to patient records and sharing test results. While some items in the bill are already part of existing privacy mandates, others may require changes to your current practices.

Read the summary (PDF, 265 KB)

Redetermination process to resume for Medi-Cal plans on April 1, 2023

March 23, 2023 – During the COVID-19 public health emergency, all Medi-Cal renewals and redeterminations that would discontinue or reduce coverage were paused. Redetermination processes will resume on April 1, 2023. Please remind members to make sure their information is up to date with their local Medi-Cal office to avoid loss of coverage.

Read about redetermination (PDF, 346 KB) 


 

2023 Plan Closures and Transitions

November 15, 2022 – The Blue Shield Coordinated Choice (HMO) plan and all Blue Shield Promise Cal MediConnect (CMC) plans end December 31, 2022. On January 1, 2023, those members will automatically transition into an existing Blue Shield Medicare Advantage Prescription Drug Plan or, in Los Angeles and San Diego Counties only, into a Dual Eligible Special Needs Plan (D-SNP). The materials below explain these plan closures and transitions, plus provide general information about D-SNPs..

View frequently asked questions (PDF, 1 MB)
Access 2023 plan closures and transitions presentation (PDF, 3.2 MB)

 

Balance billing reminder

November 1, 2022 – The Department of Health Care Services (DHCS) requested that we remind all providers to avoid balance billing. Please read the attached communication from DHCS.

View reminder (PDF, 116 KB)

 

COVID-19 therapeutics guidance for Medi-Cal providers

October 24, 2022 - Blue Shield of California Promise Health Plan has created a brief guide containing information and links to help Medi-Cal providers as they treat members for COVID-19 and support COVID-19 prevention.

Download the guide (PDF, 428 KB)

 

Easily update and attest provider directory information online

September 16, 2022 – We recently made changes to the Provider Connection website that enable you to easily attest to the accuracy of your organization’s provider directory information online and update your data when needed. These changes will make it simpler to comply with federal and state mandates, including the 2021 Consolidated Appropriations Act (CAA).

Read frequently asked questions (PDF, 1 MB)

 

Medi-Cal Rx bulletins and alerts

September 15, 2022 – The Department of Health Care Services recently posted several bulletins and alerts, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients. For your convenience, we’ve created a brief summary.

View Summary (PDF, 241 KB)

 

Medi-Cal Rx Electronic Claims Agreement – Submission deadline extended to July 31, 2022

July 15, 2022 – The Department of Health Care Services recently announced that the deadline for submitting the Medi-Cal Rx Electronic Claims Agreement has been extended to July 31, 2022.

View Summary (PDF, 191 KB)

 

COVID-19 DHCS All Plan Letter update – APL 22-004 and APL 22-009

July 22, 2022 – The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. Recently, APL 22-004 and APL 22-009 were issued to provide guidance regarding continuity of coverage and the latest testing, treatment, and prevention requirements.

View summary (PDF, 190 KB)

 

Medi-Cal Rx news – Implementation of reject code 80 postponed

July 13, 2022 – The Department of Health Care Services recently announced its decision to postpone the reinstatement of reject code 80. Reject code 88 will still be implemented as planned.

 

Major organ transplant carve-in

July 11, 2022 – As part of the CalAIM initiative, on January 1, 2022, Blue Shield of California Promise Health Plan took full responsibility for major organ transplant services for adult and non-California Children’s Services eligible pediatric transplant recipients and donors. Kidney transplants are not included in the major organ transplant category.

Read the fact sheet (PDF, 121 KB)

 

Medi-Cal Rx news – Reinstatement of reject codes 80 and 88

July 8, 2022 – The Department of Health Care Services recently announced the reinstatement of reject codes 80 - Diagnosis Code Submitted Does Not Meet Drug Coverage Criteria, and 88 - Drug Utilization Review Reject Error, effective July 22, 2022.

View Summary (PDF, 83 KB)

 

Due Date Plus app for new parents

June 2, 2022 – Have you heard about the Due Date Plus app, available for download from the App Store and Google Play? We invite you to share information about the app with members in Los Angeles and San Diego counties who are new parents.

Read about the app (PDF, 334 KB)

 

Medi-Cal DUR articles update

June 1, 2022 – Medi-Cal Drug Utilization Review (DUR) articles were posted during the past few months by the Department of Health Care Services, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients.

View Summary (PDF, 83 KB)

 

No prior authorization for specialty consultations

May 10, 2022 – Blue Shield of California Promise Health Plan recently reminded directly contracted providers in the primary care specialties that they need no prior authorization to refer Blue Shield Promise Medi-Cal members to network specialists for consultations. Following a consultation, if specialty treatment is recommended, it is necessary to check Blue Shield Promise’s prior authorization list, available on this website, to determine whether a prior authorization is needed for covered treatment.

Review notice (PDF, 31 KB)

 

COVID-19 Testing Updates for Blue Shield of California Promise Health Plan Medi-Cal Network Providers

May 10, 2022 – Read about updates regarding financial responsibility for COVID-19 diagnostic and screening testing and related costs for Medi-Cal members for dates of service on and after January 1, 2022, and how Medi-Cal members can use their Medi-Cal Rx benefits to get free COVID-19 over-the-counter at home test kits.

Review update (PDF, 30 KB)

 

Tips for talking about COVID vaccination and booster shots

February 1, 2022 - Blue Shield of California has created a two-page tip sheet to help providers continue to encourage patients to take the COVID-19 vaccine and booster shots.

Read the tip sheet (PDF, 79 KB)

 

COVID-19 vaccination incentive payment to be sent to some Medi-Cal and Cal MediConnect members

January 1, 2022 - As part of the COVID-19 Vaccination Incentive program established by the Department of Health Care Services, some Blue Shield of California Promise Health Plan members will be receiving a $50 Visa gift card as an incentive for receiving a COVID-19 vaccination shot. 

Learn more (PDF, 86 KB)


 

Formulary updates

December 7, 2021 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.

See formulary changes

 

Cal Medi-Connect (CMC) Transition to Dual-Special Needs Plan (D-SNP) provider webinar

December 6, 2021 – When CMC sunsets at the end of 2022, Blue Shield Promise members will be transferred to D-SNPs. View this recorded webinar to learn more.

Recorded Webinar (25 min)

 

Medi-Cal DUR Articles & Alerts Update

November 16, 2021 – Medi-Cal Drug Utilization Review (DUR) articles and alerts were posted during the past few months by the Department of Health Care Services, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients.

View Summary (PDF, 76 KB)

 

Communication skills for talking about the COVID vaccines

November 9, 2021 – Blue Shield of California Promise Health Plan has partnered with L.A. Care to provide a tip sheet to help providers engage more effectively with patients who are hesitant about taking the COVID-19 vaccines. Although the tip sheet was created with Medi-Cal providers in mind, the content applies to any provider.

The tip sheet includes suggested responses to patient statements and concerns, for the purpose of engaging patients in a nonjudgmental manner and linking vaccine acceptance to each patient’s hopes and goals.

Read the tip sheet  (PDF, 295 KB)

 

Sales tax reminder for Medi-Cal providers

October 20, 2021 – In accordance with Medi-Cal billing and reimbursement guidelines, since January 1, 2021, Blue Shield of California Promise Health Plan has been following the Medi-Cal guidelines regarding sales tax for incontinence, medical supplies, and durable medical equipment (DME). For your reference and convenience, we have excerpted relevant information below from the Medi-Cal Provider manuals in the attached document.

Read sales tax reminder (PDF, 88KB)

 

Postpartum Care HEDIS Tip Sheet

October 14, 2021 – L.A. Care has partnered with Blue Shield of California Promise Health Plan and other managed care plans to create a tip sheet to help providers improve their Healthcare Effectiveness Data and Information Set (HEDIS®) rates. The document lists best practices for ensuring timeliness of care and accurate documentation of postpartum services.

View Postpartum HEDIS Tip Sheet  (PDF, 162KB)

 

Timeliness of Prenatal Care HEDIS Tip Sheet

October 14, 2021 – L.A. Care has partnered with Blue Shield of California Promise Health Plan and other managed care plans to create a tip sheet to help providers improve their Healthcare Effectiveness Data and Information Set (HEDIS®) rates. The document lists best practices for ensuring timeliness of care and accurate documentation of prenatal services.

View Prenatal HEDIS Tip Sheet (PDF, 193KB)

 

Recent enhancements to Provider Connection Claims section

October 12, 2021 – We’ve updated the Claims pages on the Provider Connection website to make it easier to find claims and view more of them at once. Log in and visit the Check claim status landing page to take a tour!

Go to Check claim status

 

New extended hours for Provider Information & Enrollment – 6 a.m. to 6:30 p.m.

October 4, 2021 – The Provider Information & Enrollment team for Blue Shield of California Promise Health Plan is now available to assist you between the hours of 6 a.m. and 6:30 p.m., Monday through Friday, at (877) 912-1013. After hours and during the weekend, our automated system will receive your calls and offer guidance. Please do not hesitate to reach out if you need assistance.

 

Formulary updates

September 27, 2021 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.

See formulary changes

 

New revised claim submission process for incontinence and other medical supply products

July 20, 2021 – We are pleased to announce an update to Blue Shield of California Promise Health Plan systems which will enable providers to easily submit electronic claims and encounters for medically necessary incontinence products and other medical supply products for Medi-Cal and Cal MediConnect members, using Uniform Commercial Codes (UCCs) and other Product/Service ID codes, in addition to National Drug Codes (NDCs). This change is only applicable to professional (837P) services. For institutional (837I) claims and encounters, the 2410 loop will only accept the N4 National Drug Codes.

Read instructions (PDF, 89 KB)

 

How to download members’ ID cards

June 11, 2021 – Blue Shield of California providers can easily download members’ ID cards to access the information they need, saving time and reducing environmental waste. We’ve posted a 1-page resource on Provider Connection to show you how. (Login required.)

See instructions (PDF, 40 KB)

 

Formulary Changes

June 8, 2021 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.

See formulary changes

 

Medi-Cal DUR Articles & Alerts Update

June 4, 2021 – Medi-Cal Drug Utilization Review (DUR) articles and alerts were posted during the past few months by the Department of Health Care Services, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients.

View Summary (PDF, 73 KB)

 

COVID-19 All Plan Letters Update – Additional revisions to APL 20-022

May 21, 2021 – The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. Recently, APL 20-022 was again revised to provide additional guidance. Read a summary of the APL revisions that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 88 KB)

 

Submit medical authorization requests using AuthAccel

May 11, 2021 – We are pleased to announce the launch of additional AuthAccel functionality for Blue Shield of California Promise Health Plan providers. Available 24/7 from Blue Shield’s Provider Connection website, the tool now includes the capability to submit medical authorization requests for both Medi-Cal and Cal MediConnect members, in addition to viewing the status of previous submissions.

Learn more about AuthAccel

 

Provider Connection Enhancements

April 14, 2021 – We are pleased to announce the latest enhancements to the Provider Connection website! Changes include improved web page design in several areas, and the ability for Account Managers to use the Provider Demographics page to update the practice information that appears in the Find a Doctor tool. Please check the revised Blue Shield Promise Provider Connection Reference Guide for information about these enhancements.

View guide (PDF, 1.6 MB)

 

COVID-19 All Plan Letters Update – Revisions to APL 20-004, APL 20-022

April 5, 2021 – The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. Recently, APL 20-004 and APL 20-022 were revised to provide additional guidance. Read a summary of the APL revisions that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary

 

Medi-Cal Bulletins Update

March 23, 2021 – Updates posted during February 2021 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 70 KB)

 

New extended hours for Provider Services – 6 a.m. to 6:30 p.m.

March 16, 2021 – The Provider Services team for Blue Shield of California Promise Health Plan is now available to assist you between the hours of 6 a.m. and 6:30 p.m., Monday through Friday, at (877) 921-0362. After hours and during the weekend, our automated system will receive your calls and offer guidance. Please do not hesitate to reach out to Provider Services if you need assistance.

 

Medi-Cal DUR Articles & Alerts Update

March 15, 2021 – Medi-Cal Drug Utilization Review (DUR) articles and alerts were posted during 2020 by the Department of Health Care Services, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients.

View Summary (PDF, 78 KB)

 

Formulary Changes

February 23, 2021 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.

See formulary changes

 

COVID-19 All Plan Letters Update – APL 20-021, APL 20-022

February 11, 2021 – The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. Recently, APL 20-021 and APL 20-022 were issued to provide additional guidance. Read a summary of the APLs that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary

 

Medi-Cal Bulletins Update

February 8, 2021 – Updates posted during January 2021 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 105 KB)

 

New Medi-Cal and APL web pages

January 27, 2021 – The Blue Shield of California Promise Health Plan provider website has been updated to include five new web pages that make it easy to find summaries and other information we want to share with you based on Department of Health Care Services (DHCS) Medi-Cal bulletins, All Plan Letters (APLs), and related Blue Shield Promise programs.

See Links (PDF, 75 KB)

 

Department of Health Care Services All Plan Letter 20-016

January 25, 2021 – Read a summary of All Plan Letter 20-016 issued by the Department of Health Care Services (DHCS) entitled, “Blood Lead Screening of Young Children,” which may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 126 KB)

 

Visit the County of San Diego’s website for information on COVID-19 vaccines and more

January 22, 2021 – We are joining other healthcare organizations in San Diego County who are encouraging network providers and facilities to visit the county’s website for healthcare professionals. The website is for those who are serving in community and tribal health centers, hospitals, pharmacies, behavioral health settings, and dental clinics and provides information on enrolling as a COVID-19 vaccine provider, rollout phases, appointments, and more.

Visit the County of San Diego website

 

Medi-Cal Bulletins Update

January 19, 2021 – Updates posted during December 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 105 KB)

 

Updates to provider website regarding pharmacy benefit management

January 19, 2021 – The Blue Shield of California Promise Health Plan provider website has been updated to reflect the following changes in pharmacy benefit management, effective January 1, 2021: 1) our Medicare contract has been transferred to Blue Shield of California; 2) pharmacy claims are now processed by CVS Health; and 3) a new page has been created on the Blue Shield Promise provider website for 2020 archived formulary changes.

See changes (PDF, 73 KB)


 

Medi-Cal Rx program implementation postponed until APRIL 1, 2021

December 11, 2020 – The Department of Health Care Services (DHCS) has announced that the implementation of Medi-Cal Rx, the new state-run pharmacy benefit program originally scheduled to launch on January 1, 2021, has been postponed until April 1, 2021. Until then, all current prescription drug service processes will remain unchanged, and managed care plans such as Blue Shield of California Promise Health Plan will continue to administer pharmacy benefits for their Medi-Cal members.

Access announcement (PDF, 93 KB)

 

Proposition 56 Supplemental Payment Notification – With instructions for EFT

December 9, 2020 – Blue Shield of California Promise Health Plan is currently making supplemental payments in accordance with the California Healthcare, Research and Prevention Tobacco Tax Act (Proposition 56). We have revised our summary of processes and requirements related to these Proposition 56 payments to include instructions for electronic funds transfer (EFT). We recommend signing up for EFT to receive payments faster and avoid mail delays.

View the Proposition 56 Provider Notification (PDF, 133 KB)

 

Medi-Cal Bulletins Update

December 1, 2020 – Updates posted during November 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 72 KB)

 

Community-Based Adult Services available to Medi-Cal and Cal MediConnect patients

November 30, 2020 – Community-Based Adult Services (CBAS) are a managed care benefit available to Medi-Cal and Cal MediConnect (Dual Eligible) patients. CBAS centers provide care to eligible seniors and adults with disabilities that want to remain living at home instead of going to a nursing facility. During the COVID-19 emergency, congregate services have been suspended. However, CBAS centers continue to provide home-based care to participants through Temporary Alternative Services. Providers are encouraged to promote CBAS with potentially eligible patients and their family members or caregivers.

View Summary (PDF, 82 KB)

 

Formulary Changes

November 30, 2020 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal, Medicare, and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.

See formulary changes

 

Free training – A Physician’s Practical Guide to Culturally Competent Care

November 30, 2020 – To increase knowledge and awareness of cultural and linguistically appropriate services (CLAS), Blue Shield of California Promise Health Plan is sharing a free e-learning accredited program, entitled A Physician’s Practical Guide to Culturally Competent Care. This program provides Continuing Education Units (CEU) credits for physicians, physician assistants, nurse practitioners and any other direct service providers interested in learning about CLAS.

Access training information (PDF, 96 KB)

 

Medi-Cal Bulletins Update

November 9, 2020 – Updates posted during October 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 75 KB)

 

Phased approach to converting local codes to national codes for billing Medi-Cal claims

October 30, 2020 – Effective for dates of service after January 1, 2019, for billing claims, Blue Shield Promise will follow the Medi-Cal Fee for Service Program’s phased approach to converting local codes to national codes. Claims submitted with a local code will be accepted as long as the Department of Health Care Services has not converted the local code to a national code.

Read Notice (PDF, 67 KB)

 

Pharmacy claim vendor change effective January 1, 2021

October 30, 2020 – Effective January 1, 2021, Blue Shield of California and Blue Shield of California Promise Health Plan will transition from SS&C to CVS Health (CVSH) for pharmacy claim processing and related services for all lines of business. The transition to CVSH and enhanced data security will require each user to register with a personal login and password to access CALINX Rx data. Providers can continue to obtain CALINX Rx pharmacy claims data using the current SS&C process through January 31, 2021.

Read Notice (PDF, 70 KB)

 

Provider Connection Enhancements

October 29, 2020 – We are pleased to announce the latest enhancements to the Provider Connection website! Changes include sitewide search capability, a new claim activity dashboard, pinned claims functionality, and account management filtering and sorting. Registered Billing Service Managers can now request additional Tax ID access online. Also, the Account Manager’s Responsibilities section is now a one-stop shop for all activities an Account Manager may do. Please check the revised Provider Connection Reference Guide for information about these enhancements.

View guide (PDF, 2.4 MB)

 

COVID-19 All Plan Letters Update – Revisions to APL 20-004

October 19, 2020 – The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. Recently, APL 20-004 was revised to provide additional guidance. Read a summary of the revisions that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 83 KB)

 

Billing surgical procedures with Medi-Cal modifiers

October 19, 2020 – In accordance with Medi-Cal billing and reimbursement guidelines, effective November 1, 2020, Blue Shield of California Promise Health plan will require Medi-Cal surgical modifiers for Current Procedural Terminology (CPT) codes 10000-69999 to be included in claims submitted with dates of service on or after November 1, 2020. Claims submitted without the required modifiers will be denied.

Learn more about Medi-Cal modifiers (PDF, 104 KB)

 

Medi-Cal Rx Carve-out training available from Department of Health Care Services

October 18, 2020 – Effective January 1, 2021, Medi-Cal pharmacy benefits will be administered by the Department of Health Care Services’ (DHCS) new Medi-Cal Rx program. DHCS is offering web-based instructor-led or computer-based training about Medi-Cal Rx through a Learning Management System (LMS), called Saba. Registration is available on the Medi-Cal Rx website.

See training details (PDF, 77 KB)

 

Medi-Cal Bulletins Update

October 13, 2020 – Updates posted during September 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 74 KB)

 

Medi-Cal Bulletins Update

September 29, 2020 – Updates posted during August 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 71 KB)

 

Department of Health Care Services All Plan Letter 20-012

September 18, 2020 – Read a summary of All Plan Letter 20-012 issued by the Department of Health Care Services (DHCS) entitled, “Private Duty Nursing Case Management Responsibilities for Medi-Cal Eligible Members under the Age of 21,” which may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 78 KB)

 

Department of Health Care Services All Plan Letter 20-010

September 9, 2020 – Read a summary of All Plan Letter 20-010 issued by the Department of Health Care Services (DHCS) entitled, “Cost Avoidance and Post-Payment Recovery for Other Health Coverage,” which may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 278 KB)

 

COVID-19 All Plan Letters Update – Supplements to 2019 APLs

August 20, 2020 – The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. They have also added supplements to APLs posted during 2019 to support the pandemic. Read a summary of the supplements that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 78 KB)

 

Formulary Changes

August 20, 2020 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal, Medicare, and Cal Medi-Connect. For your convenience, we’ve provided summaries of changes that were made during the past few months.

See formulary changes

 

Annual Quality Program Information

August 20, 2020 – General essential information related to quality programs that we send to our network participants annually to ensure awareness of resources.

Review annual summary (PDF, 61 KB)

 

Suicide Prevention Tools and Resources During the COVID-19 Pandemic

August 19, 2020 – The Department of Health Care Services (DHCS), California Department of Public Health, and Office of the California Surgeon General have issued a Suicide Prevention notice, which contains tools and resources available to support suicide prevention efforts with a focus on the COVID-19 pandemic. We are sharing this notice with you at their request and encourage you to apply the information to your practice, as appropriate.

Read Notice (PDF, 90 KB)

 

Proposition 56 Supplemental Payment Notification - Revised

August 12, 2020 – Blue Shield of California Promise Health Plan (Blue Shield Promise) is currently making supplemental payments in accordance with the California Healthcare, Research and Prevention Tobacco Tax Act (Proposition 56). We have revised our summary of processes and requirements related to these Proposition 56 payments to include APL 20-014.

View the Proposition 56 Provider Notification (PDF, 126 KB)

 

Medi-Cal Bulletins Update

August 12, 2020 – Updates posted during July 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 70 KB)

 

COVID-19 All Plan Letters Update

July 17, 2020 – During the month of June 2020, the Department of Health Care Services revised two All Plan Letters (APLs) related to the COVID-19 crisis. APL 20-004 and APL 20-011 were revised. Read a summary of the revisions that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 88 KB)

 

Medi-Cal Bulletins Update

July 15, 2020 – Updates posted during June 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 72 KB)

 

Proposition 56 Supplemental Payment Notification

June 25, 2020 – Blue Shield of California Promise Health Plan (Blue Shield Promise) is currently making supplemental payments in accordance with the California Healthcare, Research and Prevention Tobacco Tax Act (Proposition 56). Specifically, within the next several weeks, if they meet qualifying requirements, providers may receive a supplemental payment and details regarding services rendered that are eligible under one or more of the relevant All Plan Letters issued by the Department of Health Care Services We have provided a summary of our processes for managing payments, inquiries, grievances and disputes related to these Proposition 56 payments, in addition to screening requirements for APL 19-016 and APL 19-018.

View the Proposition 56 Provider Notification (PDF, 117 KB)

 

Blue Shield of California’s Health Reimagined Supports Ongoing Innovation and Helps Address Hardships Exposed by COVID-19

June 25, 2020 – Blue Shield of California is working closely with medical providers, local and regional stakeholders, and collaborating with technology firms to bring the best ideas and solutions to the market. Learn how this effort addresses long-standing access, equity, cost and quality issues that have been further exposed during the COVID-19 pandemic.

Learn how Blue Shield is transforming health care

 

Department of Health Care Services All Plan Letter 20-007

June 17, 2020 – Read a summary of All Plan Letter 20-007 issued by the Department of Health Care Services (DHCS) to Community-Based Adult Services (CBAS) providers, which may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 104 KB)

 

Medi-Cal Bulletins Update

June 16, 2020 – Updates posted during May 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (PDF, 66 KB)

 

Formulary Changes

June 5, 2020 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal, Medicare, and Cal Medi-Connect. For your convenience, we’ve provided summaries of changes that were made during the past few months.

See formulary changes

 

COVID-19 All Plan Letters Update

June 4, 2020 – Read a summary of the All Plan Letters (APLs) issued by the Department of Health Care Services (DHCS) in the past several weeks regarding COVID-19 that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (162 KB)

 

Medi-Cal Bulletins Update

May 26, 2020 – Updates posted during April 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (72 KB)

 

Blue Shield of California Announces Financial Support Options to Healthcare Providers in Response to COVID-19 Crisis

April 23, 2020 – As part of an over $200 million commitment to support healthcare providers and hospitals facing financial pressures resulting from the coronavirus (COVID-19) pandemic, Blue Shield of California has announced four programs available to its network providers.

Learn more details now at Blue Shield’s news center

 

Medi-Cal DUR Articles & Alerts Update

April 22, 2020 – Medi-Cal Drug Utilization Review (DUR) articles and alerts were posted during Q4 2019 by the Department of Health Care Services, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients.

View Summary (70 KB)

 

Updated Due Date Plus App available for expecting and new parents

April 21, 2020 – The latest version of Due Date Plus® is now available for download from the App Store® and Google Play™. We invite you to share this news with your patients in Los Angeles and San Diego counties who are expecting or are new parents.

Read about the app (78 KB)

 

Medi-Cal Bulletins Update

April 8, 2020 – Updates posted during Q1 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (85 KB)

 

Formulary Changes

April 1, 2020 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal, Medicare, and Cal Medi-Connect. For your convenience, we’ve provided summaries of changes that were made during the past few months.

See formulary changes

 

Medi-Cal Bulletins Update

March 31, 2020 – Updates posted during Q4 2019 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (79 KB)

 

Medi-Cal Bulletins Update

January 28, 2020 – Updates posted during 2019 by the Department of Health Care Services regarding important topics you need to know about when providing services to Blue Shield of California Promise Health Plan Medi-Cal members.

View Summary (100 KB)

 

Introducing the redesigned Provider Resources section

January 2, 2020 – You may notice a different "look and feel" to the format of the website, including the section we previously called "Provider Resources."

We have redesigned the Provider Resources section to improve navigation. You will continue to find forms, updates, program information, medical and medication policies here, but more easily. This part of the website does not require logging in, so you can access these resources at any time. You will see that a new landing page in the Providers section will allow you to quickly link to specific resources that are used often.

As we continue to enhance our website resources, we hope you will find our new format helpful. We encourage you to check this section periodically for new announcements.


 

Medi-Cal Bulletins Update

October 14, 2019 – Updates posted by the Department of Health Care Services regarding important topics you need to know about when providing services to Blue Shield of California Promise Health Plan Medi-Cal members.

Read summary. (PDF, 84 KB)

 

APL 19-010

October 4, 2019 – Network provider update regarding this All Plan Letter 19-010 issued by the Department of Health Care Services regarding requirements to provide early and periodic screening, treatment, diagnostic and treatment services (EPSDT) to eligible members under the age of 21.

View notice (PDF, 145 KB)

 

Annual Quality Program Information

August 6, 2019 – General essential information related to quality programs that we send to our network participants annually to ensure awareness of resources.

Review annual summary (PDF, 86 KB)


 

Medi-Cal Quality Improvement Bulletin

Read this quarterly bulletin to learn about Blue Shield Promise quality program opportunities, provider and member incentives, and more.

Register for webinars

Sign up for upcoming webinars about working with Blue Shield Promise and our members.

Name change and data migration updates

Stay informed of updates and resources that support our new infrastructure since January 1, 2019.

Medi-Cal bulletin summaries

Review summaries of the latest bulletins posted by the Department of Health Care Services.

All Plan Letter summaries

See what guidelines and requirements have been posted in the latest Department of Health Care Services All Plan Letters (APLs).

Provider Connection

Access network provider tools on Provider Connection website.

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。

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

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