Managing Electronic Claims and Encounters
Blue Shield of California Promise Health Plan requires that you submit all encounters electronically. We encourage you to submit all your claims and receive your payments electronically as well, for faster processing and payment, using electronic data interchange (EDI).
EDI allows paperless encounter submissions, as well as billing and payment for healthcare services and supplies, automating many types of routine inquiries.
EDI benefits
- Reduced administrative costs. The average physician's office can save up to $46,000 annually using electronic transactions for common administrative tasks, according to a report by The Milliman Group (PDF, 96KB)
- Improved accuracy of billing and posting information
- Reduced office paperwork
- Improved cash flow
- Faster claims processing
- Improved security for protected information
Using EDI, you can automatically post electronic remittance advice (ERA) to your practice management system, reducing data entry, speeding up patient billing, and freeing up staff for more important tasks.
Get started today with one of these two approved clearinghouses:
OfficeAlly
Payer ID: C1SCA
(866) 575-4120
Change Healthcare Claims
Payer ID: 57115
(866) 371-9066
Get paid electronically
Electronic funds transfer (EFT) allows you to have your claims payments deposited directly into your business account, minimizing your risk of lost checks or lockbox delays.
EDI inquiry
If you have questions on electronic claim submissions or EDI 837/835 files, submit an online EDI inquiry.
EDI Companion Guides
Access our companion guides for trading partners who exchange electronic transactions directly with us.
Sign up for electronic remittance advice and electronic payments
Find the information and forms you need to enroll in ERA and EFT.
Local code encounter crosswalk
Find the national codes that must replace local billing codes. For billing claims, Blue Shield Promise continues to utilize Medi-Cal local codes following the Medi-Cal Fee-for-Service Program's phased approach to convert the interim (local) codes to national values.
National Drug Code requirements for reporting physician administered drugs
Learn about Blue Shield Promise code submission requirements for submitting claims and encounters when reporting physician administered drugs for Medi-Cal and Cal MediConnect members.
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.