Blue Shield Behavioral Health resources

Behavioral health resources for your patients with any of our benefit plans

Blue Shield of California recently transitioned management of behavioral health services for certain HMO and PPO plans and services from external management to full internal management, beginning January 1, 2026.  By bringing these plans and services “in-house,” Blue Shield offers a more streamlined and connected experience for both members and providers, including all services for Applied Behavioral Analysis (ABA) services for eligible members.

We look forward to working directly you and your patients to provide behavioral health support and guidance for patients with Blue Shield commercial HMO or PPO, Medicare Advantage HMO or PPO, Federal Employee Program PPO, or Blue Shield of California Promise Health Plan Medi-Cal plans.

We stand ready to collaborate with you to thoughtfully integrate mental health services with primary medical care by providing access to the programs, options and tools best suited to your patients’ needs. The resources below are available to assist you in guiding or referring your patients to specialists and programs, as well as where to find information for managing your business needs directly with Blue Shield for authorizations, claims submissions and more.

Read Frequently Asked Questions to learn more about the transition to Blue Shield Behavioral Health.

Collaborative Care Model 

Blue Shield works directly with primary care practices to integrate mental health into primary care settings using the Collaborative Care Model (CoCM) developed by the University of Washington’s AIMS Center, on an evidence-based, team-driven approach.

Learn about working with us and the opportunities for your practice to sign up for this program and receive training and resources supporting the Collaborative Care Model.

Authorizations and referrals

Care for Blue Shield plan members that does not need authorization:

• Emergency services
• Initial assessments
• Outpatient therapy
• Outpatient medication management (usually with a psychiatrist)
• Psychological testing

Care for Blue Shield plan members that does need referral/authorization.

Visit our Authorizations section on this website for details on managing authorizations for members with HMO, PPO, and Federal Employee Program PPO plans for these services:

• Acute care
• Applied behavioral analysis (ABA therapy)
• Electroconvulsive therapy (ECT)
• Intensive Outpatient Program (IOP)
• Neuropsychological testing
• Partial Hospital Program (PHP)
• Residential Treatment Center (RTC)
• Transcranial Magnetic Stimulation (TMS)

Blue Shield commercial HMO and PPO and Medicare Advantage HMO and PPO plan members and Federal Employee Program (FEP) PPO plan members

Members with these plans may find and self-refer to a full list of behavioral health resources available on our mental health and substance use website for members. Review the lists above, however, to identify which services will need authorization or referral.

Commercial HMO plan members

Commercial HMO plan members are assigned to IPA/medical groups. Some IPA/medical groups carry the risk for behavioral health care for their assigned members, managing authorizations and referrals. When checking the member’s eligibility and benefits, be certain to note whether you need to submit authorization requests to their assigned IPA/medical group, or directly to Blue Shield. For Blue Shield authorizations, visit our Authorizations section on this Provider Connection website.

For care needing authorizations for commercial PPO plan members, refer to the same Authorizations section to find how to submit those requests. 

Medicare Advantage HMO and PPO plan members

Blue Shield Medicare Advantage HMO and PPO plan members may find and self-refer to multiple resources via Blue Shield’s mental health and substance use resources, including self-guided resources and information on accessing specialized care, and how to find specialists using our online Find a doctor tool.

Some members may need care that requires referral and/or authorization.

• Medicare Advantage Prescription Drug HMO plan members
  • Medicare Advantage Prescription Drug Plan (IMAPD) HMO members
  • Blue Shield TotalDual Plan (HMO D-SNP)
    
    If your primary care practice needs to refer a patient to care that requires referrals and/or authorizations, you can work directly with us for PPO plan members. For HMO members, you may be working directly with the member’s assigned IPA/medical group, to refer them for assessment and collaboration in creating an appropriate treatment plan.

Complete this D-SNP and IMAPD Behavioral Health Care Management Referral Form (PDF, 131 KB), then email the completed form to the Blue Shield care team at the email address supplied on the form. The email address for submission will depend on your patient’s type of benefit plan.

• Group Medicare Advantage Prescription Drug (GMAPD) PPO plan members
  If your patient with a GMAPD PPO benefit plan needs specialized care that requires a referral and/or authorization, visit our Authorizations section on this Provider Connection website to learn how to manage authorizations. 

Blue Shield of California Promise Health Plan members

Program resources specific to Blue Shield Promise members are available in the Behavioral Health Services for Blue Shield Promise Medi-Cal members section on our Blue Shield Promise provider website.

Specialty Care

Qualified autism service professionals - Applied Behavioral Analysis (ABA)

Effective January 1, 2024, California Senate Bill 805 (SB 805) expanded the definition of qualified autism service professionals (QASP) to include psychological associates, associate marriage and family therapists, associate clinical social workers, and associate professional clinical counselors. The bill also requires that those who qualify as a QASP meet the training and experience criteria established by the California Department of Developmental Services by July 1, 2026.  

In accordance with the law, Blue Shield encourages all participating network providers to comply with the changes made via SB 805 to Health & Safety Code Section 1374.73 and Insurance Code Section 10144.51.

Use our Find a doctor tool to search for any provider specialties in our Behavioral Health Network.  

Enter any type of specialty in the tool to look for the specialty you are seeking. Please note that if you are searching for an ABA specialist, it is best to spell out “Applied Behavioral Analysis.”

Screening Tools

Maternal mental health screening

Blue Shield asks that practitioners use an evidence-based screening tool to screen for maternal mental health conditions at least once per trimester and within six weeks postpartum.

Blue Shield’s Maternal Mental Health Screening Pathways (PDF, 290 KB) is a clinical tool to help practitioners conduct perinatal mental health screenings, submit billing codes for reimbursement, and link Blue Shield members to resources and treatment.

Members may also self-refer for Maternity Health support resources online at blueshieldca.com.

California Mental Health Parity Law Compliance

In compliance with California Senate Bill 855 (SB 855), Blue Shield provides access to those clinical guidelines and educational materials Blue Shield uses to make medical necessity determinations for mental health and substance use disorder services to members, authorized representatives, and providers, to ensure transparency in coverage decisions based on medical necessity.

 Read Blue Shield’s compliance statement (PDF, 383 KB)

Additional tools for healthcare practitioners

• Read Blue Shield’s approach to behavioral health utilization management.
• Find prior authorization forms for medical and behavioral health.
• Find descriptions for Conditions and care programs.
• Visit the Clinical Practice Guidelines and Shared Decision-making aids page.
• Explore our online Health Library for health topics with helpful resources, including articles and interactive tools available at the bottom of the Conditions and care programs page.
• Review the Care options and Life Referrals 24/7 community resources available to plan members.
• Search for behavioral health or other specialists in our Blue Shield Behavioral Health Network in our Find a doctor tool.

Contacts

If you don’t find what you need online, we are available to assist you. Call Blue Shield Behavioral Health at (877) 263-9952, to inquire about eligibility, benefits and claims specific to behavioral health.