Clinical Policies, Procedures, and Guidelines
Learn about our policies, requirements, criteria for evaluating and applying new technologies, and procedures that comprise our medical care solutions:
- Medical policies and guidelines
- Medical care solutions
- Prior authorization list
- Prior authorization and referral forms
- Pharmacy services information and drug formularies
Medical care solutions
Review medical care solutions for Blue Shield Promise plans.
Prior authorization list
View the list of medical services and procedures requiring medical necessity review or supplemental documentation prior to payment.
Clinical practice guidelines and shared decision-making aids
Clinical practice guidelines define healthcare standards applicable to members and providers.
Pharmacy services and drug formularies
Review drug formularies for Cal MediConnect and find pharmacy services information.
Policies, guidelines, standards and forms
Find provider manuals, provider dispute resolution policies, medical record, access to care standards, and more.
Prior authorization and referral forms
Find common forms which you may need to request prior authorization, as well as patient referral forms.
Access network provider tools on Provider Connection website.