Claims should be submitted to Blue Shield of California via the Real-Time Claims web tool or electronically using Electronic Data Interchange, though they can also be submitted by mail.

Prescreen claims

Clear Claim Connection (C3) is a simulation tool that enables providers to transparently view claim auditing rules, payment policies and clinical rationales for professional and facility claims across Individual, Small Group, Employer Group, Medicare Advantage, Shared Advantage, FEP, and Medicare Supplement plans. C3 does not submit claims and is not a guarantee of member eligibility or claim payment. It is a tool used to test codes on mock claims and reference their rationales from nationally recognized sources.

Providers can enter CPT and HCPCS coding scenarios and immediately view the audit result. By prescreening claims, you will minimize your administrative costs and simplify doing business with us.

To get started using Clear Claim Connection, review the How to Prescreen Claims (PDF, 405 KB) quick start guide.

Submitting claims in real time

Claims can be estimated and submitted via our Real-Time Claims web tool and adjudicated in 3-9 seconds. The estimator feature provides transparency in the claim submission process by identifying submission errors and providing cost share information before each claim is submitted. By drastically reducing the amount of time needed for claims adjudication, Real-Time Claims enables more rapid payment for services. 

At this time, the Real-Time Claims web tool supports medical and hospital claims submitted for Blue Shield fully insured commercial PPO members who have a single healthcare policy, and HMO member claims for which Blue Shield is financially responsible. Covered California plans are similarly supported.

To start utilizing Real-Time Claims, ask your account manager to give you access to the tool.

Learn more about Real-Time Claims.

Submitting claims electronically

Blue Shield encourages healthcare providers to submit claims and receive payments electronically in order to reduce administrative costs and improve cash flow. Please visit Enroll in EDI for more information.

Using EDI, you can submit all of your claims and receive your payments electronically for faster processing and payment. EDI allows paperless billing and payment for healthcare services and supplies and automates many types of routine inquiries.

To enroll in electronic payment options and learn more about using EDI to save time and money, see our Manage electronic transactions page.

Sign up for a live webinar to learn about submitting electronic claims and receiving electronic payment, including tips for claims submission, and live Q&A with the experts.

Submitting claims by mail

If you still need to submit paper claims, use the Claims-Routing Tool to determine the correct mailing address for each member.

Because claims mailing addresses are different for different Blue Plan members, using the Claims Routing Tool is the most accurate way to determine a claims mailing address.

However, if you are unable to use the Claims Routing Tool, you can access our list of claims mailing addresses.