To verify a member's plan, please either log in or register. Our goal is to help you quickly and easily find out if you, the provider, or a provider referral, participate in the member's plan.
*Blue Shield of California Member Plans Only
Policies and Guidelines
In This Section
Review claim submission requirements for labs, specialty pharmacy and DME providers that will be strictly enforced beginning October 14, 2012.
Follow these easy steps to enroll in EDI for your organization, either through a clearinghouse or directly with Blue Shield of California.
Review recent NCCI edits to physician and hospital outpatient payment policies by codes and services.
Read an overview of Blue Shield's payment-processing policies and rules.
HMO IPA/medical groups can view a listing of high cost injectables, updated quarterly.
Special guidelines for CMS 1500 and UB-04 claims to help physicians submit these forms properly and process claims efficiently.
Check the time frames for the submission, acknowledgement, payment and adjustment of claims.