provider connection
 

Provider Help

Account Registration and Log In

Account Management

Authorizations

For help and step-by-step instructions on requesting authorizations and viewing authorization status, please visit the AuthAccel online authorization training page.


Claims

Contact Us
Eligibility and Benefits
Manage Profile
Reference

Account Registration and Log in


Create an Account
If you've never accessed Provider Connection before and do not have a user ID or password, below are some tips to help you with creating an account.

You will need to submit your:
  • Tax ID Number (TIN) or Social Security Number (SSN).
    • IPAs/medical groups must provide the correct TIN associated with the Blue Shield PIN.
    • Individual providers must provide the correct SSN associated with the Blue Shield PIN.
A provider organization Tax ID Number (TIN) is required to register as an Account Manager and determines the provider-related information that account may access.

Provider ID Number (PIN) is an identifier assigned by Blue Shield used within Blue Shield to uniquely identify a billing provider and all data associated with that provider.
  • If no Account Manager is assigned to your TIN, you can become an Account Manager or designate an Account Manager for the TIN you entered.
    • If you decide to become an Account Manager, you'll be asked to agree to the terms required of an Account Manager before continuing with your registration as an Account Manager.
You will then need to enter your provider information and enter a user ID and password:
  • Choose a user ID that is between 8 and 20 characters long. Do not include punctuation, special characters or spaces.
  • Choose a password that is at least 8 characters long and contains characters from at least two of the following groups:
    • Uppercase letters (A-Z)
    • Lowercase letters (a-z)
    • Numerals (0-9)
    • Special characters (!@#$%^&*()<>?)
      Examples: great!scott, julie2jones, 234*5678
Please make a note of the user ID and password you entered, as you will need them each time you log in to Provider Connection.

If you agreed to become an Account Manager, you will need to complete a legal disclosure form to obtain approval to access secure member information. This step is critical to help us maintain secure records and protect private health information.
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Log In
Login is required to access the secure features of Provider Connection. You must have an account before you can log in. An Account Manager registered for your organization must create a user account for you. You will need your user ID and password to log in.

To log in:
  • Enter your user ID in the "User ID" field.

  • Enter your password in the "Password" field.

  • Click the "Log In" button.


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Account Management


The functionality described below is for Account Managers only. If you are not an Account Manger and have questions about account management, please contact your Account Manager.

Assign a Tax ID Number (TIN) and the corresponding Blue Shield Provider ID Number(s) (PIN) for a user.

Only Account Managers registered as a business category of "Provider" may add a Tax ID Number to the account. Account Managers registered as other than "Provider" must submit a request offline using the Legal Disclosure Form Addendum.

Account Managers can select the Tax ID Numbers (TINs) and the corresponding Blue Shield Provider ID Numbers (PINs) for an individual user. Provider Connection displays all the TINs for which the Account Manager is registered.

De-selecting the TIN checkbox will prevent the user from accessing information for a specific provider organization's TIN, including all associated PINs. PINs may be selected or de-selected individually. Selecting all TIN checkboxes will allow the user to access all data for that provider organization.

To determine the TINs and PINs for a user:
  • Select each TIN and associated PINs that you want the user to be able to access.

  • To prevent a user from viewing data associated with a specific TIN or PIN, un-check the box adjacent to that TIN or PIN.

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Manage User Accounts
View the list of registered users you manage, reset user passwords, and add, edit, transfer or delete a user account. The list of accounts can be sorted by Name, User ID, Role, Access (level of access), Email address, the Modified date, or account Status.

To edit a user's account information or to reset a user's password, select the user ID from the list of accounts. Update the user's account information on the Edit Account page, then click "Save and Finish" or "Save and Edit Tax IDs" to update the TINs associated with this user's account.

Update TINs associated with a user's account by selecting or de-selecting the Tax IDs this user account should have access to/be associated with. When finished, click "Save and Finish." You can exit this area anytime by clicking "I want to exit."

To reset a user's password, select the user ID from the list of accounts. On the Edit Account page, click the "Reset Password" button and the user's password will be reset to "Password!".

An Account Manager may transfer a user account to another Account Manager at any time, provided another Account Manager is eligible to receive a transfer. The receiving Account Manager must be registered with the same provider organization(s) as the transferring Account Manager.

To transfer a user's account, select the account using the checkbox next to the account name, then click the "Transfer" button. The system will display the Account Managers eligible (if any) to receive the transfer.

If no other Account Manager is eligible to receive a transfer, you will need to coordinate with another Account Manager to ensure he/she is registered with the same provider organization(s) as the user account you wish to transfer. Both the user account and the new Account Manager must be registered under the same Tax ID numbers.

To find Account Manager contact information for TINs associated with your account, select "Account Managers by Tax ID." Select a TIN to see associated Account Manager contact information.

Account status is either "Active" or "Inactive." Only an Account Manager can disable or re-activate a user account. Many Account Managers prefer to disable an account rather than delete it. The result is the same: the user account can no longer access any secure feature.

An Account Manager may delete a user account at any time. Keep in mind that this will permanently delete this user's account.

Please note: Deleting an Account Manager's account may have the effect of disabling all of the user accounts under that Account Manager. You should transfer these user accounts before disabling or deleting an Account Manager account.
Download a spreadsheet of user accounts by clicking "Download-List" and saving the file to your hard drive when prompted.
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Update Provider Account Information
Add and remove Tax ID Numbers (TINs) associated with your organization as well as update your organization's contact information.

To add TINs:
  • Enter the TIN in the field.

  • Click the "Add Tin" button.

The TIN will move from the field on the left to the list on the right. Repeat these steps until all TINs are entered.

To remove TINs:
  • Select the TIN to remove from the list.

  • Click the "Remove TIN" button.

The TIN will be removed from the field. Repeat these steps until all desired TINs are removed.

To change contact information, select the appropriate field and enter the new information. Click the "Submit" button to save your changes.

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Claims


BlueCard Prefix Tool
To find where you should send a BlueCard?claim, enter the alpha prefix and the date of service.

The alpha prefix is the three-character alphabetic prefix that precedes a Blue Cross or Blue Shield member's identification number.

The alpha prefix identifies the home plan the member belongs to and is the key element on the ID card for routing claims to the member's home plan.

The date of service is the month, day, and year of when a Blue Cross or Blue Shield member received medical services from the provider. Enter the date of service in mm/dd/yyyy format.
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Bulk Check Detail
Provider Connection provides a list of the claims that are associated with a check number. You can view the list of claims for a check number and access the details for an individual claim. Click on the claim number to access detailed claim information.
Please Note: You may only view checks that are associated with your Blue Shield Provider ID Number (PIN).
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Claims Activity Report
Provider Connection allows you to retrieve pending claims and claims that were finalized within the previous 90 days. You can create a list of claims that are associated with your Blue Shield Provider ID Number (PIN).

To create a list of claims:
  1. Select your provider locations in the locations box (hold down the Ctrl key to select multiple locations).
  2. Enter your search criteria (i.e. date range, place of service, status, billed amount, etc.).
  3. Click the "Search" button. The list will include a separate listing for each PIN that is associated with your organization to distinguish between multiple addresses or facilities associated with one provider.
This search function will allow you to perform searches on hundreds of claims at a time, and you can download the results into a spreadsheet-compatible file which can then be saved on your own system.
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Claims Search by Member
You can search for claims submitted by Blue Shield of California, other Blue plan (including BlueCardO and Federal Employee Program (FEP) members.

To search for a single Blue Shield of California member's claim records:
  1. Choose "Blue Shield of California" as the card type.
  2. Enter the subscriber ID or the member's first name, last name and date of birth. You can also search by patient account number.
  3. Click the "Search" button.
To refine your results, you can use the advanced search option and enter more criteria.

To search for claim records for a member enrolled with a Blue plan other than Blue Shield of California:
  1. Choose "Other Blue plan" as the card type.
  2. Select the type of member. The subscriber is the primary member, while dependents are any other family member covered by the subscriber's plan.
  3. For subscribers, enter the member ID, the member's last name, first name and date of birth, select your tax ID, and then enter the service from date, service to date and amount billed. All fields are required.
Please Note: Beginning 5/23/07, NPI will also be required.
Information about members enrolled with another Blue plan is provided by the member's home plan. The home plan is responsible for the quality and availability of that information.

For dependents, you must enter the subscriber's last name in addition to the items in step 3 above.

To refine your results, you can use the advanced search option and enter more criteria.
  • After entering additional search criteria, click the "Search" button, or to view results later instead of waiting for the search, click "Send results to Message Center." When the search is complete, you'll receive the results as a message in your Message Center.
To search for a single FEP member's claim records:
  1. Choose "Federal employee" as the card type. You can identify an FEP member by the ID prefix -- it will begin with the prefix ranging from R00 to R99.
  2. Enter the subscriber ID or the member's first name, last name and date of birth.
  3. Click the "Search" button.
To refine your results, you can use the advanced search option and enter more criteria.

Search results will include claims records that are associated with your Blue Shield Provider ID Number (PIN).

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Message Center
The Message Center is where you receive messages about eligibility, benefits and claims search results you've requested. Each user account has its own Message Center - only you can see your messages.

You can access Message Center from any page in Provider Connection by clicking the link in the top navigation. When you have new messages, you'll see an alert at the top of your home page of Provider Connection.

Unread messages appear in bold. Once you've opened a message it will no longer appear in bold. You may mark a viewed message as unread by clicking the box in the "Select" column and then clicking the "Mark as Unread" button.

Read messages are deleted after 45 days. To manually delete any message, click the box in the "Select" column, then click the "Delete" button. Once you delete a message, it is permanently removed from the system and cannot be retrieved.

You can sort your messages by clicking a column title. Click a column title to toggle between descending order (column arrow pointing up) and ascending order (arrow pointing down).

Eligibility, benefits and claims search results that cannot be retrieved within 45 seconds are automatically sent to your Message Center when the search results are ready. return to top

Contact Us


Assistance & Contact Information
If you need help using the site, your Provider Relations Coordinator or Contract Manager can provide a demonstration of the site features as well as assist you with the registration process.

If you need help obtaining your Blue Shield Provider ID Number (PIN), you may contact Blue Shield's Provider Services Liaison Unit at:
(800) 258-3091

For technical issues or problems, please submit a technical support form or contact us at
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Eligibility and Benefits


Benefits Details
This section displays detailed benefits information for a member. The benefits information is structured to follow the member's Evidence of Coverage format. However, to make finding information easier, the benefits categories are displayed alphabetically in categories and sub-categories. You may search for a category, or scroll down the list of categories.

The search functionality for the benefits categories includes a comprehensive thesaurus of commonly used medical terminology and abbreviations to enable you to search for specific benefit information.

To search for benefits information:
  1. Enter the term to search for.
  2. Click the SEARCH button.
  3. Search results will appear in the "Benefit Categories" column. Select a category to view the details to the right.
Please Note: You may view current or historical benefits coverage data for a specific time period by selecting a period from the "Coverage Period" drop-down.
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Deductible/Out of Pocket Details
The Deductible/Out of Pocket details display accumulative and current deductible and out of pocket information. The Deductible amount is the initial amount members must pay in a calendar year (January 1 through December 31) for certain covered services before they become eligible to receive certain benefits. The Out of Pocket amount is the total amount that a member has to pay in out-of-pocket expenses for covered services received during any calendar year of coverage. You can create a printer-friendly report of deductible and out-of-pocket details for a member by clicking the Printer-Friendly Report link.

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Eligibility and Benefits Multiple Search
You can search for eligibility and benefits for up to 10 Blue Shield of California members at a time.

You can't search for multiple other Blue plan (including BlueCardO or Federal Employee Progam (FEP) members at the same time, and you can't mix Blue Shield of California members and other Blue plan or FEP members in the same search. To search for other Blue plan or FEP members, please use Single Search.

To search for multiple members:
  1. Click the "Multiple Search" tab on the Eligibility and Benefits landing page.
  2. Select "Blue Shield of California" as card type.
  3. Enter the subscriber ID and date of birth for up to 10 members. Subscriber ID and date of birth are required fields.
  4. Click the "Search" button. If you click the "Clear" button, it will delete all information entered.
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Eligibility and Benefits Single Search
You can search for eligibility and benefits information for Blue Shield of California, other Blue plan (including BlueCardO and Federal Employee Program (FEP) members.

To search for a Blue Shield of California member:
  1. Choose "Blue Shield of California" as the card type.
  2. Enter the subscriber ID and date of birth or the member's last name, first name and date of birth. The subscriber ID and date of birth or the member's last name, first name and date of birth are required fields.
  3. Click the "Search" button.
To search for a member enrolled with a Blue plan other than Blue Shield of California:
  1. Choose "Other Blue plan" as the card type.
  2. Select the type of member. The subscriber is the primary member, while dependents are any other family member covered by the subscriber's plan.
  3. For subscribers, enter the member ID, last name and first name, date of birth, gender, and eligibility date. These are all required fields.
Please Note: Beginning 5/23/07, NPI will also be required. For dependents, you must enter the subscriber's last name in addition to the items in step 3 above.

  • Click the "Search" button. To view results later instead of waiting for the search, click "Send results to Message Center." When the search is complete, you'll receive it as a message in your Message Center.
To search for an FEP member:
  1. Choose "Federal employee" as the card type. You can identify an FEP member by the ID prefix -- it will begin with the prefix R00 to R99.
  2. Select the type of member. The subscriber is the primary member, while dependents are any other family member covered by the subscriber's plan.
  3. Enter the member ID, last name and first name, date of birth, gender, and eligibility date. These are all required fields. For dependents, you must enter the subscriber's last name in addition to the items in step 3 above.

Please Note: Beginning 5/23/07 NPI will also be required
  • Click the "Search" button. To view results later instead of waiting for the search, click "Send results to Message Center." When the search is complete, you'll receive it as a message in your Message Center.
Other Blue plan and FEP member information is provided by the member's home plan. The home plan is responsible for the quality and availability of the information.
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Eligibility Details
This section displays general eligibility information for a member. The information includes current and historical coverage details. You can create a printer-friendly report of the eligibility information by clicking the Printer-Friendly Report link. return to top



Message Center
Message Center is your place to receive messages with eligibility, benefits and claims search results that you've requested. Each user account has its own Message Center, so that only you can see your messages.

You can access Message Center from any page by clicking the link in the top navigation. When you have new messages, you'll see an alert at the top of your home page of Provider Connection.

Unread messages appear in bold. Once you've opened a message it will no longer appear in bold. You may mark a viewed message as unread by clicking the box in the "Select" column and then clicking "Mark as Unread."

Messages are deleted after 45 days. To manually delete any message, click the box in the "Select" column, and then click "Delete." Once you delete a message, it is permanently removed from our system and cannot be retrieved.

You may sort your messages by clicking a column title.. The first click (arrow pointing up) sorts in descending order. To sort by ascending order, click the column title again (arrow pointing down).

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Personal Care Physician (PCP) Details
This section displays current and historical personal physician information. If the member does not have a Personal Physician, the page will display the message; "No PCP assigned to this member".

You can create a printer-friendly report of the personal physician information by clicking the Printer-Friendly Report link.

Quickview
This section displays information found in the Eligibility, PCP and Deductible/Out of Pocket sections on one scrollable page.

You can create a printer-friendly report of this information by clicking the Printer-Friendly Report link. return to top

Manage Profile


Change Password
You must change your Provider Connection password when you first log into the website or after your password has been reset by an account manager or Web Help Desk. If your password has expired, you will see the "Change Password" page.

To change your password:
  1. On the Manage My Profile page, select the "Change Password" link. The Manage My Profile page is linked in the upper text navigation.
  2. Enter a new password in the "New password" field.
  3. Enter the new password again in the "Confirm new password" field.
  4. Click the "Submit" button to create your new password.
If your account has been deactivated, contact your Account Manager or Technical Support, or contact us at 1-800-541-6652.

Forgot username and password?
If you have forgotten your username and password, we can send you your username or reset your password for you.

Please Note:The password must be entered twice to ensure it was entered correctly. Passwords may not be shared with other users within your organization. return to top

Edit My Profile

Update your account profile or change your password from this page, linked in the upper text navigation. return to top