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Policies and Guidelines

Learn more about submitting claims and rules for payment, including time frames for submitting, contesting or adjusting a claim as well as special guidelines for electronic and paper claims forms.

In This Section

Ancillary Claims Filing Guidelines

Review claim submission requirements for labs, specialty pharmacy and DME providers that will be strictly enforced beginning October 14, 2012.

Enroll in Electronic Data Interchange

Follow these easy steps to enroll in EDI for your organization, either through a clearinghouse or directly with Blue Shield of California.

NCCI edits - physician and hospital outpatient

Review recent NCCI edits to physicians and hospital outpatient providers.

Payment Policies and Rules

Read an overview of Blue Shield's payment processing policies and rules.

Richman Injectables

HMO IPA/medical groups can view a listing of high-cost injectables, updated quarterly.

Special Guidelines for Claim Forms

Special guidelines for CMS 1500 and UB-04 claims to help physicians submit these forms properly and process claims efficiently.