BLUE SHIELD OF CALIFORNIA PROMISE HEALTH PLAN PROVIDER NETWORK
At Blue Shield of California Promise Health Plan, we understand the importance of developing and maintaining solid relationships with healthcare providers, as well as the barriers that underserved California communities face in accessing healthcare services.
Through our Medi-Cal and Cal MediConnect plans and provider networks, we strive to ensure that Californians have access to quality, affordable care.
We think the same way you do
At Blue Shield Promise, you'll find a level of understanding and communication that helps both your practice and your patients. Since our executive leadership includes physicians, we value a “patients first” philosophy of care. We strive to work closely with you, be responsive, and understand the challenges your practice or provider organization faces in providing care. Our goals include providing programs and opportunities that demonstrate our dedication to supporting quality improvements in health care.
Blue Shield Promise provider networks
Blue Shield Promise’s networks comprise more than 7,000 physicians, 80 hospitals, and hundreds of ancillary medical professionals. As a mixed-model HMO health plan, Blue Shield Promise contracts with individual physicians, and with independent physician associations (IPAs) and medical groups on a capitated basis. Under the IPA/medical group arrangements, operational functions are delegated, with Blue Shield Promise providing oversight.
Our mixed model also offers an opportunity for independent physicians and other provider types to contract directly with Blue Shield Promise under flexible reimbursement methodologies.
Interested in becoming part of the Blue Shield Promise provider network?
If you are an Ancillary provider who is interested in joining our network, you can submit a Letter of Interest by the following methods:
Blue Shield of California Promise Health Plan
601 Potrero Grande Dr.
Monterey Park, CA 91755
Attention: Provider Contracting
Please include the following information with your Letter of Interest:
- Preprinted tax documents: Social Security-4 form or letter from IRS and a W/9 Form
- National Provider Identifier (NPI): Include a printout from the NPPES Registry
- Service area by city and county
- Specialty services e.g., equipment, bariatric, languages
- Proof of enrollment (within 12 months for new providers) with Medicare and Medi-Cal lines of business
- Professional Liability Insurance Certificate. Minimum requirement is $1M per occurrence/3M in aggregate)
There is a 90-day minimum turnaround for review of complete submissions. Partial/incomplete submissions will not be considered until all required documentation is received. Please do not send an email to inquire about status; a letter will be sent to you following determination. If you would like to obtain information regarding your submission, please contact Blue Shield Promise’s Provider Contracting department at (800) 468-9935.
We are available to assist you
We encourage you to find what you need on this website, at your convenience. When you can't find what you need online, our dedicated Provider Services phone line is available:
Phone:(800) 468-9935, 6 a.m. to 6:30 p.m., Monday through Friday.
Review our Quick Reference Phone Guide (PDF, 129 KB)
Blue Shield Promise Medi-Cal Provider Orientation
In addition to completing the contracting and credentialing process, the Department of Health Care Services’ (DHCS) contract with Blue Shield Promise requires that all new providers participating in our network complete orientation training within ten business days of active status. Training includes Medi-Cal Managed Care services, policies, procedures, and changes to existing processes.
To meet this training requirement, click the link below and complete the attestation at the end of the module.
Register to access member eligibility, claims, and authorizations information online
As a Blue Shield Promise network participant, you can access member eligibility, claims, and authorizations information online.
Complete and submit our Provider Login Assignment Form
Download Provider Login Assignment Form (PDF, 713 KB)
Provider support and incentive programs
Read about the programs we offer to support our network providers.