News and announcements
News and announcements 2024
Required access to breast pumps and WIC
December 13, 2024 - Please remember the appropriate timing for supporting maternity benefits for members, including ordering breast pumps near the end of the third trimester and referring expecting patients to the Women, Infants & Children (WIC) program as early as the first trimester.
Read the full reminder (PDF, 206 KB)
DispatchHealth Services are Available to Eligible Blue Shield of California Promise Health Plan Members
November 25, 2024 - We are pleased to announce that DispatachHealth® is available to eligible Blue Shield of California Promise Health plan Medi-Cal members with serious health concerns to provide same-day, high acuity medical care in the comfort of their home, reducing unnecessary ambulance trips and costly visits to the emergency room. In addition, DispatchHealth provides proactive post-acute visits for members transitioning from hospital to home, also known as “bridge care.”
Download a DispatchHealth flyer to learn more (PDF, 823 KB)
Read DispatchHealth frequently asked questions (PDF, 616 KB)
New resources available regarding medical claims billing for professional services provided by pharmacists
November 18, 2024 – As part of California Assembly Bill 317 (AB 317) Blue Shield of California Promise Health Plan accepts medical claims for pharmacist professional services that are eligible for reimbursement. Blue Shield Promise has recently developed and released resources to assist pharmacists in billing for professional services.
Download a quick reference guide for more information (PDF, 1.7 MB)
Change to Requirements for IPA Authorization Log Submissions, beginning January 1, 2025
October 11, 2024 - Beginning January 1, 2025, All Blue Shield of California Promise Health Plan (Blue Shield Promise) network IPA/medical groups will be required to submit authorization logs for medical and/or pharmacy medical benefit services processed for members using the authorization log submission capability on our Provider Connection website. This Provider Connection authorization submission process is for IPAs that are currently sending authorization logs via email or who use secure file transfer protocol (SFTP) to send authorization logs in the IPA9 format. Starting January 1, 2025, Blue Shield Promise will no longer accept authorization log email or IPA9 SFTP submissions. If you already send your logs via IPA10 SFTP, this is not applicable.
Review the IPA authorization log tutorial for more information
2024 Provider Cultural Awareness and Linguistics Resources and Training Available
October 7, 2024 - Blue Shield of California Promise Health Plan has developed cultural awareness and linguistics reference materials to assist network providers in giving the highest level of quality care and services to our health plan members. These resources include links to a free online cultural competency in care training with continuing education unit (CEU) credits, demographics and language services information, translation services, and translated materials.
Reporting Provider Preventable Conditions
October 1, 2024 – Blue Shield of California Promise Health Plan requires all network participants to report Provider Preventable Conditions (PPCs) to the Department of Health Care Services (DHCS) using the DHCS secure online reporting portal and to also inform Blue Shield Promise about the report.
California Electronic Visit Verification (CalEVV) Data Integrity Notice
August 22, 2024 – The Department of Health Care Services (DHCS) recently released California Electronic Visit Verification (CalEVV) Information Notice 24-01: Data Integrity Guidelines. The notice includes guidelines for ensuring data integrity processes are upheld by caregivers, providers, and jurisdictional entities.
View Data Integrity Guidelines
Initial Health Appointments supported by DispatchHealth
August 22, 2024 – Effective April 22, 2024, Blue Shield of California Promise Health plan is working with DispatchHealth to start the Initial Health Appointment (IHA) process in member homes. We hope that completing several IHA tasks at member homes will help us to increase IHA completion rates, connect members to their primary care physician sooner, and provide members with greater access to care overall.
Read the DispatchHealth IHA Overview (PDF, 299 KB)
LOINC codes needed for reporting depression screenings
April 22, 2024 – To meet HEQMS and HEDIS® standards, providers need to document depression screenings using LOINC® codes (Logical Observation Identifiers Names and Codes). While LOINC codes are not required for claims payment, not meeting these standards may negatively impact quality incentive payouts.
Read about depression screenings and LOINC codes
Free fentanyl test strips available through the Naloxone Distribution Project
April 18, 2024 – The Department of Health Care Services (DHCS) recently announced that it is expanding the Naloxone Distribution Project to include free fentanyl test strips. These may be used to detect the presence of fentanyl in drug samples prior to ingestion, to help prevent accidental overdose. Eligible organizations throughout the state of California can obtain fentanyl test strips and/or naloxone at no cost through an online application.
New address for claims sent by postal mail
April 1, 2024 – Blue Shield of California Promise Health Plan has a new address for claims that need to be sent by postal mail: Blue Shield of California Promise Health Plan, P.O. Box 272660, Chico, CA 95927-2660. Please update your records and use this address going forward as needed.
California Electronic Visit Verification (CalEVV) training opportunities
March 21, 2024 – The California Electronic Visit Verification (CalEVV) team is providing voluntary, in-person training events at various locations across the state. The in-person training will provide you with tools, resources, and state guidance around provider compliance, roles and responsibilities, as well as other EVV requirements.
California Electronic Visit Verification (CalEVV) office hours
March 21, 2024 – The California Electronic Visit Verification (CalEVV) team is providing in-person office hours at various locations across the state. No registration is required.
Download the flyer (PDF, 2 MB)
Enhanced Care Management flyer available
March 21, 2024 – Blue Shield of California Promise Health Plan offers Enhanced Care Management to eligible members with complex needs that make it difficult to improve their health. This could include chronic health conditions or socioeconomic challenges such as not having a place to live. To identify who qualifies, please refer to our Enhanced Care Management flyer.
Download the flyer (PDF, 809 KB)
Long-Term Support and Services Liaisons
March 13, 2024 – Blue Shield of California Promise Health Plan has designated three Long-Term Support and Services (LTSS) Liaisons to assist long-term care facilities in addressing claims and payment inquiries and managing care transitions to best support members’ needs.
Contact LTSS Liaisons (PDF, 157 KB)
New postal address for provider dispute resolution requests
March 6, 2024 – Blue Shield of California Promise Health Plan has a new postal address for provider dispute resolution requests that need to be submitted in writing: FirstSource – BSCPHP PDR, PO Box 8309, Chico, CA 95927-8309. Please remember to include a completed Provider Dispute Resolution Request form with your mailings.
New Physician Certification Statement form for requesting NEMT for members
January 30, 2024 – Blue Shield of California Promise Health Plan is pleased to announce an updated Physician Certification Statement (PCS) form for physicians to use when requesting non-emergency medical transportation (NEMT) for Blue Shield Promise members with Medi-Cal health coverage. We have updated this form to clarify the providers permitted to authorize NEMT.
California Electronic Visit Verification (CalEVV) codes update
January 17, 2024 – Effective January 1, 2024, the California Electronic Visit Verification (CalEVV) team implemented several changes, which are summarized in the announcement linked below. Please be sure to use EVV for all home-based encounters.
GED benefit available for members aged 18 and older
January 16, 2024 – Members aged 18 years and older can get free help preparing for and taking the General Education Development (GED) test through the GEDWorks™ program. Please share this flyer with your patients.
AB 1241 telehealth policy clarification
January 9, 2024 – California Assembly Bill 1241 (AB 1241) says that if a patient requests services be provided in person instead of via telehealth and their provider cannot accommodate them, the provider should arrange for a referral to a provider who can provide in-person care. A recent update clarifies that the provider is not required to schedule an appointment with a different provider on behalf of the patient.
News and announcements 2023
December 7 – Enhanced Care Management and Community Supports Townhall
December 7, 2023 – L.A. Care is sponsoring a townhall webinar for L.A. County providers on Thursday, December 7, 2023, at 10:00 a.m. The topic is “Enhanced Care Management and Community Supports.”
Learn more and register for the webinar (PDF, 128 KB)
Billing reminder – Entering correct National Drug Codes for physician-administered drugs
December 1, 2023 – Blue Shield of California Promise Health Plan requires providers to bill physician-administered drugs (PADs) using National Drug Codes (NDC) according to Medi-Cal guidelines that accurate claim information is required for drug reimbursement.
Read guidelines (PDF, 230 KB)
New online dispute functionality
November 28, 2023 – You can now file disputes online for Blue Shield Promise Medi-Cal claims. The new functionality includes the ability to submit bulk disputes for multiple claims.
Subacute Care Facilities – DHCS SCU contract applications due December 15, 2023
November 16, 2023 – Effective January 1, 2024, Medi-Cal managed care plans in all counties must ensure that members in need of adult or pediatric subacute care services are placed in a healthcare facility that is under contract for subacute care with the California Department of Health Care Services (DHCS) Subacute Contracting Unit (SCU) or is actively in the process of applying for a contract with SCU. To receive Medi-Cal reimbursement, facilities must have a Subacute Care Program contract with DHCS SCU. Facilities must submit an application to SCU by December 15, 2023.
Read the Subacute Contracting fact sheet
Equity and Practice Transformation (EPT) Payment Program
October 13, 2023 – The Department of Health Care Services is implementing a one-time $700 million primary care provider practice transformation program to advance health equity and reduce COVID-19-driven care disparities. Find out if your provider organization qualifies for directed payments. Applications are due to DHCS on October 23, 2023, at 11:59 p.m.
Read the program description (PDF, 405 KB)
Provider Directory enhancement: Indicate that a provider offers gender affirming care
September 19, 2023 – We have recently updated the Blue Shield of California Promise Health Plan provider directory to enable you to indicate if a provider or organization offers gender affirming care services. This will allow members to use the Find a Doctor tool to connect with providers who offer these services. Please note that this identification should only be used for providers of specific gender affirming care services.
Read about the enhancement (PDF, 204 KB)
Health education materials and video library
June 30, 2023 – We are pleased to announce that we have a new health education materials and video library! Materials are available in English and Spanish. You may print materials as needed for Blue Shield of California Promise Health Plan members. Printed copies of materials or materials in other languages or alternative formats are also available.
Use of filter paper should be discontinued for blood lead screening
June 12, 2023 – Per advisement from the California Department of Public Health Childhood Lead Poisoning Prevention Branch, use of filter paper testing should be discontinued for blood lead tests due to well-documented issues of possible contamination.
Read filter paper update (PDF, 232 KB)
New Blue Shield of California Promise Health Plan Medi-Cal Quality Improvement Bulletin
May 11, 2023 – Blue Shield of California Promise Health Plan now offers a periodic Medi-Cal Quality Improvement Bulletin to provide current information about the programs we offer in collaboration with our network healthcare providers, with the goal of providing our Medi-Cal members with access to quality care. Topics will range from information on events, how Blue Shield Promise rewards practices through provider incentive programs, details about related opportunities for clinical interventions, and more.
Review Quality Improvement Bulletin
End of COVID-19 public health emergency
May 11, 2023 – The COVID-19 national public health emergency expired on May 11, 2023. While some temporary waivers and flexibilities ended, other policies have been continued to meet ongoing patient needs. Please visit our COVID-19 APL Updates page for the most recent changes to Medi-Cal requirements for managed care plans.
Healthy Rewards Program incentivizes Medi-Cal members to take care of their health
May 10, 2023 – Blue Shield of California Promise Health Plan offers an innovative Healthy Rewards Program to help improve the quality of care of our Medi-Cal plan members by rewarding them for completing preventive screenings.
When a Blue Shield Promise Medi-Cal plan member completes a health care activity by December 31, 2023, and notifies us it is complete, we will send them a reward of their choice from the options available. The more activities they complete, the more they will earn.
Please direct Blue Shield Promise Medi-Cal members with questions to call Icario at (866) 549-4627, TTY 711. Representatives at the Icario call center are available from 5 a.m. to 7 p.m., Monday through Friday and 7 a.m. to 12 p.m., on Saturday.
How Senate Bill 1419 affects access to patient records and the sharing of test results
April 6, 2023 – Read a summary of California Senate Bill 1419 requirements for managing access to patient records and sharing test results. While some items in the bill are already part of existing privacy mandates, others may require changes to your current practices.
Read the summary (PDF, 265 KB)
Redetermination process to resume for Medi-Cal plans on April 1, 2023
March 23, 2023 – During the COVID-19 public health emergency, all Medi-Cal renewals and redeterminations that would discontinue or reduce coverage were paused. Redetermination processes will resume on April 1, 2023. Please remind members to make sure their information is up to date with their local Medi-Cal office to avoid loss of coverage.
Read about redetermination (PDF, 346 KB)
News and announcements 2022
2023 Plan Closures and Transitions
November 15, 2022 – The Blue Shield Coordinated Choice (HMO) plan and all Blue Shield Promise Cal MediConnect (CMC) plans end December 31, 2022. On January 1, 2023, those members will automatically transition into an existing Blue Shield Medicare Advantage Prescription Drug Plan or, in Los Angeles and San Diego Counties only, into a Dual Eligible Special Needs Plan (D-SNP). The materials below explain these plan closures and transitions, plus provide general information about D-SNPs..
View frequently asked questions (PDF, 1 MB)
Access 2023 plan closures and transitions presentation (PDF, 3.2 MB)
Balance billing reminder
November 1, 2022 – The Department of Health Care Services (DHCS) requested that we remind all providers to avoid balance billing. Please read the attached communication from DHCS.
View reminder (PDF, 116 KB)
COVID-19 therapeutics guidance for Medi-Cal providers
October 24, 2022 - Blue Shield of California Promise Health Plan has created a brief guide containing information and links to help Medi-Cal providers as they treat members for COVID-19 and support COVID-19 prevention.
Download the guide (PDF, 440 KB)
Easily update and attest provider directory information online
September 16, 2022 – We recently made changes to the Provider Connection website that enable you to easily attest to the accuracy of your organization’s provider directory information online and update your data when needed. These changes will make it simpler to comply with federal and state mandates, including the 2021 Consolidated Appropriations Act (CAA).
Read frequently asked questions (PDF, 1 MB)
Medi-Cal Rx bulletins and alerts
September 15, 2022 – The Department of Health Care Services recently posted several bulletins and alerts, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients. For your convenience, we’ve created a brief summary.
View Summary (PDF, 241 KB)
Medi-Cal Rx Electronic Claims Agreement – Submission deadline extended to July 31, 2022
July 15, 2022 – The Department of Health Care Services recently announced that the deadline for submitting the Medi-Cal Rx Electronic Claims Agreement has been extended to July 31, 2022.
View Summary (PDF, 191 KB)
COVID-19 DHCS All Plan Letter update – APL 22-004 and APL 22-009
July 22, 2022 – The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. Recently, APL 22-004 and APL 22-009 were issued to provide guidance regarding continuity of coverage and the latest testing, treatment, and prevention requirements.
View summary (PDF, 190 KB)
Medi-Cal Rx news – Implementation of reject code 80 postponed
July 13, 2022 – The Department of Health Care Services recently announced its decision to postpone the reinstatement of reject code 80. Reject code 88 will still be implemented as planned.
Major organ transplant carve-in
July 11, 2022 – As part of the CalAIM initiative, on January 1, 2022, Blue Shield of California Promise Health Plan took full responsibility for major organ transplant services for adult and non-California Children’s Services eligible pediatric transplant recipients and donors. Kidney transplants are not included in the major organ transplant category.
Read the fact sheet (PDF, 121 KB)
Medi-Cal Rx news – Reinstatement of reject codes 80 and 88
July 8, 2022 – The Department of Health Care Services recently announced the reinstatement of reject codes 80 - Diagnosis Code Submitted Does Not Meet Drug Coverage Criteria, and 88 - Drug Utilization Review Reject Error, effective July 22, 2022.
View Summary (PDF, 83 KB)
Due Date Plus app for new parents
June 2, 2022 – Have you heard about the Due Date Plus app, available for download from the App Store and Google Play? We invite you to share information about the app with members in Los Angeles and San Diego counties who are new parents.
Read about the app (PDF, 334 KB)
Medi-Cal DUR articles update
June 1, 2022 – Medi-Cal Drug Utilization Review (DUR) articles were posted during the past few months by the Department of Health Care Services, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients.
View Summary (PDF, 83 KB)
No prior authorization for specialty consultations
May 10, 2022 – Blue Shield of California Promise Health Plan recently reminded directly contracted providers in the primary care specialties that they need no prior authorization to refer Blue Shield Promise Medi-Cal members to network specialists for consultations. Following a consultation, if specialty treatment is recommended, it is necessary to check Blue Shield Promise’s prior authorization list, available on this website, to determine whether a prior authorization is needed for covered treatment.
Review notice (PDF, 31 KB)
COVID-19 Testing Updates for Blue Shield of California Promise Health Plan Medi-Cal Network Providers
May 10, 2022 – Read about updates regarding financial responsibility for COVID-19 diagnostic and screening testing and related costs for Medi-Cal members for dates of service on and after January 1, 2022, and how Medi-Cal members can use their Medi-Cal Rx benefits to get free COVID-19 over-the-counter at home test kits.
Review update (PDF, 30 KB)
Tips for talking about COVID vaccination and booster shots
February 1, 2022 - Blue Shield of California has created a two-page tip sheet to help providers continue to encourage patients to take the COVID-19 vaccine and booster shots.
Read the tip sheet (PDF, 79 KB)
COVID-19 vaccination incentive payment to be sent to some Medi-Cal and Cal MediConnect members
January 1, 2022 - As part of the COVID-19 Vaccination Incentive program established by the Department of Health Care Services, some Blue Shield of California Promise Health Plan members will be receiving a $50 Visa gift card as an incentive for receiving a COVID-19 vaccination shot.
Learn more (PDF, 86 KB)
News and announcements 2021
Formulary updates
December 7, 2021 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
Cal Medi-Connect (CMC) Transition to Dual-Special Needs Plan (D-SNP) provider webinar
December 6, 2021 – When CMC sunsets at the end of 2022, Blue Shield Promise members will be transferred to D-SNPs. View this recorded webinar to learn more.
Recorded Webinar (25 min)
Medi-Cal DUR Articles & Alerts Update
November 16, 2021 – Medi-Cal Drug Utilization Review (DUR) articles and alerts were posted during the past few months by the Department of Health Care Services, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients.
View Summary (PDF, 76 KB)
Communication skills for talking about the COVID vaccines
November 9, 2021 – Blue Shield of California Promise Health Plan has partnered with L.A. Care to provide a tip sheet to help providers engage more effectively with patients who are hesitant about taking the COVID-19 vaccines. Although the tip sheet was created with Medi-Cal providers in mind, the content applies to any provider.
The tip sheet includes suggested responses to patient statements and concerns, for the purpose of engaging patients in a nonjudgmental manner and linking vaccine acceptance to each patient’s hopes and goals.
Read the tip sheet (PDF, 295 KB)
Sales tax reminder for Medi-Cal providers
October 20, 2021 – In accordance with Medi-Cal billing and reimbursement guidelines, since January 1, 2021, Blue Shield of California Promise Health Plan has been following the Medi-Cal guidelines regarding sales tax for incontinence, medical supplies, and durable medical equipment (DME). For your reference and convenience, we have excerpted relevant information below from the Medi-Cal Provider manuals in the attached document.
Read sales tax reminder (PDF, 88KB)
Postpartum Care HEDIS Tip Sheet
October 14, 2021 – L.A. Care has partnered with Blue Shield of California Promise Health Plan and other managed care plans to create a tip sheet to help providers improve their Healthcare Effectiveness Data and Information Set (HEDIS®) rates. The document lists best practices for ensuring timeliness of care and accurate documentation of postpartum services.
View Postpartum HEDIS Tip Sheet (PDF, 162KB)
Timeliness of Prenatal Care HEDIS Tip Sheet
October 14, 2021 – L.A. Care has partnered with Blue Shield of California Promise Health Plan and other managed care plans to create a tip sheet to help providers improve their Healthcare Effectiveness Data and Information Set (HEDIS®) rates. The document lists best practices for ensuring timeliness of care and accurate documentation of prenatal services.
View Prenatal HEDIS Tip Sheet (PDF, 193KB)
Recent enhancements to Provider Connection Claims section
October 12, 2021 – We’ve updated the Claims pages on the Provider Connection website to make it easier to find claims and view more of them at once. Log in and visit the Check claim status landing page to take a tour!
New extended hours for Provider Information & Enrollment – 6 a.m. to 6:30 p.m.
October 4, 2021 – The Provider Information & Enrollment team for Blue Shield of California Promise Health Plan is now available to assist you between the hours of 6 a.m. and 6:30 p.m., Monday through Friday, at (877) 912-1013. After hours and during the weekend, our automated system will receive your calls and offer guidance. Please do not hesitate to reach out if you need assistance.
Formulary updates
September 27, 2021 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
New revised claim submission process for incontinence and other medical supply products
July 20, 2021 – We are pleased to announce an update to Blue Shield of California Promise Health Plan systems which will enable providers to easily submit electronic claims and encounters for medically necessary incontinence products and other medical supply products for Medi-Cal and Cal MediConnect members, using Uniform Commercial Codes (UCCs) and other Product/Service ID codes, in addition to National Drug Codes (NDCs). This change is only applicable to professional (837P) services. For institutional (837I) claims and encounters, the 2410 loop will only accept the N4 National Drug Codes.
Read instructions (PDF, 89 KB)
How to download members’ ID cards
June 11, 2021 – Blue Shield of California providers can easily download members’ ID cards to access the information they need, saving time and reducing environmental waste. We’ve posted a 1-page resource on Provider Connection to show you how. (Login required.)
See instructions (PDF, 40 KB)
Formulary Changes
June 8, 2021 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
Medi-Cal DUR Articles & Alerts Update
June 4, 2021 – Medi-Cal Drug Utilization Review (DUR) articles and alerts were posted during the past few months by the Department of Health Care Services, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients.
View Summary (PDF, 73 KB)
COVID-19 All Plan Letters Update – Additional revisions to APL 20-022
May 21, 2021 – The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. Recently, APL 20-022 was again revised to provide additional guidance. Read a summary of the APL revisions that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 88 KB)
Submit medical authorization requests using AuthAccel
May 11, 2021 – We are pleased to announce the launch of additional AuthAccel functionality for Blue Shield of California Promise Health Plan providers. Available 24/7 from Blue Shield’s Provider Connection website, the tool now includes the capability to submit medical authorization requests for both Medi-Cal and Cal MediConnect members, in addition to viewing the status of previous submissions.
Provider Connection Enhancements
April 14, 2021 – We are pleased to announce the latest enhancements to the Provider Connection website! Changes include improved web page design in several areas, and the ability for Account Managers to use the Provider Demographics page to update the practice information that appears in the Find a Doctor tool. Please check the revised Blue Shield Promise Provider Connection Reference Guide for information about these enhancements.
View guide (PDF, 1.6 MB)
COVID-19 All Plan Letters Update – Revisions to APL 20-004, APL 20-022
April 5, 2021 – The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. Recently, APL 20-004 and APL 20-022 were revised to provide additional guidance. Read a summary of the APL revisions that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
Medi-Cal Bulletins Update
March 23, 2021 – Updates posted during February 2021 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 70 KB)
New extended hours for Provider Services – 6 a.m. to 6:30 p.m.
March 16, 2021 – The Provider Services team for Blue Shield of California Promise Health Plan is now available to assist you between the hours of 6 a.m. and 6:30 p.m., Monday through Friday, at (877) 921-0362. After hours and during the weekend, our automated system will receive your calls and offer guidance. Please do not hesitate to reach out to Provider Services if you need assistance.
Medi-Cal DUR Articles & Alerts Update
March 15, 2021 – Medi-Cal Drug Utilization Review (DUR) articles and alerts were posted during 2020 by the Department of Health Care Services, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients.
View Summary (PDF, 78 KB)
Formulary Changes
February 23, 2021 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
COVID-19 All Plan Letters Update – APL 20-021, APL 20-022
February 11, 2021 – The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. Recently, APL 20-021 and APL 20-022 were issued to provide additional guidance. Read a summary of the APLs that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
Medi-Cal Bulletins Update
February 8, 2021 – Updates posted during January 2021 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 105 KB)
New Medi-Cal and APL web pages
January 27, 2021 – The Blue Shield of California Promise Health Plan provider website has been updated to include five new web pages that make it easy to find summaries and other information we want to share with you based on Department of Health Care Services (DHCS) Medi-Cal bulletins, All Plan Letters (APLs), and related Blue Shield Promise programs.
See Links (PDF, 75 KB)
Department of Health Care Services All Plan Letter 20-016
January 25, 2021 – Read a summary of All Plan Letter 20-016 issued by the Department of Health Care Services (DHCS) entitled, “Blood Lead Screening of Young Children,” which may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 126 KB)
Visit the County of San Diego’s website for information on COVID-19 vaccines and more
January 22, 2021 – We are joining other healthcare organizations in San Diego County who are encouraging network providers and facilities to visit the county’s website for healthcare professionals. The website is for those who are serving in community and tribal health centers, hospitals, pharmacies, behavioral health settings, and dental clinics and provides information on enrolling as a COVID-19 vaccine provider, rollout phases, appointments, and more.
Visit the County of San Diego website
Medi-Cal Bulletins Update
January 19, 2021 – Updates posted during December 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 105 KB)
Updates to provider website regarding pharmacy benefit management
January 19, 2021 – The Blue Shield of California Promise Health Plan provider website has been updated to reflect the following changes in pharmacy benefit management, effective January 1, 2021: 1) our Medicare contract has been transferred to Blue Shield of California; 2) pharmacy claims are now processed by CVS Health; and 3) a new page has been created on the Blue Shield Promise provider website for 2020 archived formulary changes.
See changes (PDF, 73 KB)
News and announcements 2020
Medi-Cal Rx program implementation postponed until APRIL 1, 2021
December 11, 2020 – The Department of Health Care Services (DHCS) has announced that the implementation of Medi-Cal Rx, the new state-run pharmacy benefit program originally scheduled to launch on January 1, 2021, has been postponed until April 1, 2021. Until then, all current prescription drug service processes will remain unchanged, and managed care plans such as Blue Shield of California Promise Health Plan will continue to administer pharmacy benefits for their Medi-Cal members.
Access announcement (PDF, 93 KB)
Proposition 56 Supplemental Payment Notification – With instructions for EFT
December 9, 2020 – Blue Shield of California Promise Health Plan is currently making supplemental payments in accordance with the California Healthcare, Research and Prevention Tobacco Tax Act (Proposition 56). We have revised our summary of processes and requirements related to these Proposition 56 payments to include instructions for electronic funds transfer (EFT). We recommend signing up for EFT to receive payments faster and avoid mail delays.
View the Proposition 56 Provider Notification (PDF, 133 KB)
Medi-Cal Bulletins Update
December 1, 2020 – Updates posted during November 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 72 KB)
Community-Based Adult Services available to Medi-Cal and Cal MediConnect patients
November 30, 2020 – Community-Based Adult Services (CBAS) are a managed care benefit available to Medi-Cal and Cal MediConnect (Dual Eligible) patients. CBAS centers provide care to eligible seniors and adults with disabilities that want to remain living at home instead of going to a nursing facility. During the COVID-19 emergency, congregate services have been suspended. However, CBAS centers continue to provide home-based care to participants through Temporary Alternative Services. Providers are encouraged to promote CBAS with potentially eligible patients and their family members or caregivers.
View Summary (PDF, 82 KB)
Formulary Changes
November 30, 2020 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal, Medicare, and Cal MediConnect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
Free training – A Physician’s Practical Guide to Culturally Competent Care
November 30, 2020 – To increase knowledge and awareness of cultural and linguistically appropriate services (CLAS), Blue Shield of California Promise Health Plan is sharing a free e-learning accredited program, entitled A Physician’s Practical Guide to Culturally Competent Care. This program provides Continuing Education Units (CEU) credits for physicians, physician assistants, nurse practitioners and any other direct service providers interested in learning about CLAS.
Access training information (PDF, 96 KB)
Medi-Cal Bulletins Update
November 9, 2020 – Updates posted during October 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 75 KB)
Phased approach to converting local codes to national codes for billing Medi-Cal claims
October 30, 2020 – Effective for dates of service after January 1, 2019, for billing claims, Blue Shield Promise will follow the Medi-Cal Fee for Service Program’s phased approach to converting local codes to national codes. Claims submitted with a local code will be accepted as long as the Department of Health Care Services has not converted the local code to a national code.
Read Notice (PDF, 67 KB)
Pharmacy claim vendor change effective January 1, 2021
October 30, 2020 – Effective January 1, 2021, Blue Shield of California and Blue Shield of California Promise Health Plan will transition from SS&C to CVS Health (CVSH) for pharmacy claim processing and related services for all lines of business. The transition to CVSH and enhanced data security will require each user to register with a personal login and password to access CALINX Rx data. Providers can continue to obtain CALINX Rx pharmacy claims data using the current SS&C process through January 31, 2021.
Read Notice (PDF, 70 KB)
Provider Connection Enhancements
October 29, 2020 – We are pleased to announce the latest enhancements to the Provider Connection website! Changes include sitewide search capability, a new claim activity dashboard, pinned claims functionality, and account management filtering and sorting. Registered Billing Service Managers can now request additional Tax ID access online. Also, the Account Manager’s Responsibilities section is now a one-stop shop for all activities an Account Manager may do. Please check the revised Provider Connection Reference Guide for information about these enhancements.
View guide (PDF, 2.4 MB)
COVID-19 All Plan Letters Update – Revisions to APL 20-004
October 19, 2020 – The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. Recently, APL 20-004 was revised to provide additional guidance. Read a summary of the revisions that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 83 KB)
Billing surgical procedures with Medi-Cal modifiers
October 19, 2020 – In accordance with Medi-Cal billing and reimbursement guidelines, effective November 1, 2020, Blue Shield of California Promise Health plan will require Medi-Cal surgical modifiers for Current Procedural Terminology (CPT) codes 10000-69999 to be included in claims submitted with dates of service on or after November 1, 2020. Claims submitted without the required modifiers will be denied.
Learn more about Medi-Cal modifiers (PDF, 104 KB)
Medi-Cal Rx Carve-out training available from Department of Health Care Services
October 18, 2020 – Effective January 1, 2021, Medi-Cal pharmacy benefits will be administered by the Department of Health Care Services’ (DHCS) new Medi-Cal Rx program. DHCS is offering web-based instructor-led or computer-based training about Medi-Cal Rx through a Learning Management System (LMS), called Saba. Registration is available on the Medi-Cal Rx website.
See training details (PDF, 77 KB)
Medi-Cal Bulletins Update
October 13, 2020 – Updates posted during September 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 74 KB)
Medi-Cal Bulletins Update
September 29, 2020 – Updates posted during August 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 71 KB)
Department of Health Care Services All Plan Letter 20-012
September 18, 2020 – Read a summary of All Plan Letter 20-012 issued by the Department of Health Care Services (DHCS) entitled, “Private Duty Nursing Case Management Responsibilities for Medi-Cal Eligible Members under the Age of 21,” which may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 78 KB)
Department of Health Care Services All Plan Letter 20-010
September 9, 2020 – Read a summary of All Plan Letter 20-010 issued by the Department of Health Care Services (DHCS) entitled, “Cost Avoidance and Post-Payment Recovery for Other Health Coverage,” which may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 278 KB)
COVID-19 All Plan Letters Update – Supplements to 2019 APLs
August 20, 2020 – The Department of Health Care Services has issued several All Plan Letters (APLs) to Medi-Cal managed care providers in response to the current COVID-19 crisis. They have also added supplements to APLs posted during 2019 to support the pandemic. Read a summary of the supplements that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 78 KB)
Formulary Changes
August 20, 2020 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal, Medicare, and Cal Medi-Connect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
Annual Quality Program Information
August 20, 2020 – General essential information related to quality programs that we send to our network participants annually to ensure awareness of resources.
Review annual summary (PDF, 61 KB)
Suicide Prevention Tools and Resources During the COVID-19 Pandemic
August 19, 2020 – The Department of Health Care Services (DHCS), California Department of Public Health, and Office of the California Surgeon General have issued a Suicide Prevention notice, which contains tools and resources available to support suicide prevention efforts with a focus on the COVID-19 pandemic. We are sharing this notice with you at their request and encourage you to apply the information to your practice, as appropriate.
Read Notice (PDF, 90 KB)
Proposition 56 Supplemental Payment Notification - Revised
August 12, 2020 – Blue Shield of California Promise Health Plan (Blue Shield Promise) is currently making supplemental payments in accordance with the California Healthcare, Research and Prevention Tobacco Tax Act (Proposition 56). We have revised our summary of processes and requirements related to these Proposition 56 payments to include APL 20-014.
View the Proposition 56 Provider Notification (PDF, 126 KB)
Medi-Cal Bulletins Update
August 12, 2020 – Updates posted during July 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 70 KB)
COVID-19 All Plan Letters Update
July 17, 2020 – During the month of June 2020, the Department of Health Care Services revised two All Plan Letters (APLs) related to the COVID-19 crisis. APL 20-004 and APL 20-011 were revised. Read a summary of the revisions that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 88 KB)
Medi-Cal Bulletins Update
July 15, 2020 – Updates posted during June 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 72 KB)
Proposition 56 Supplemental Payment Notification
June 25, 2020 – Blue Shield of California Promise Health Plan (Blue Shield Promise) is currently making supplemental payments in accordance with the California Healthcare, Research and Prevention Tobacco Tax Act (Proposition 56). Specifically, within the next several weeks, if they meet qualifying requirements, providers may receive a supplemental payment and details regarding services rendered that are eligible under one or more of the relevant All Plan Letters issued by the Department of Health Care Services We have provided a summary of our processes for managing payments, inquiries, grievances and disputes related to these Proposition 56 payments, in addition to screening requirements for APL 19-016 and APL 19-018.
View the Proposition 56 Provider Notification (PDF, 117 KB)
Blue Shield of California’s Health Reimagined Supports Ongoing Innovation and Helps Address Hardships Exposed by COVID-19
June 25, 2020 – Blue Shield of California is working closely with medical providers, local and regional stakeholders, and collaborating with technology firms to bring the best ideas and solutions to the market. Learn how this effort addresses long-standing access, equity, cost and quality issues that have been further exposed during the COVID-19 pandemic.
Learn how Blue Shield is transforming health care
Department of Health Care Services All Plan Letter 20-007
June 17, 2020 – Read a summary of All Plan Letter 20-007 issued by the Department of Health Care Services (DHCS) to Community-Based Adult Services (CBAS) providers, which may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 104 KB)
Medi-Cal Bulletins Update
June 16, 2020 – Updates posted during May 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (PDF, 66 KB)
Formulary Changes
June 5, 2020 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal, Medicare, and Cal Medi-Connect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
COVID-19 All Plan Letters Update
June 4, 2020 – Read a summary of the All Plan Letters (APLs) issued by the Department of Health Care Services (DHCS) in the past several weeks regarding COVID-19 that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (162 KB)
Medi-Cal Bulletins Update
May 26, 2020 – Updates posted during April 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (72 KB)
Blue Shield of California Announces Financial Support Options to Healthcare Providers in Response to COVID-19 Crisis
April 23, 2020 – As part of an over $200 million commitment to support healthcare providers and hospitals facing financial pressures resulting from the coronavirus (COVID-19) pandemic, Blue Shield of California has announced four programs available to its network providers.
Learn more details now at Blue Shield’s news center
Medi-Cal DUR Articles & Alerts Update
April 22, 2020 – Medi-Cal Drug Utilization Review (DUR) articles and alerts were posted during Q4 2019 by the Department of Health Care Services, with information to improve the quality and cost-effectiveness of prescribing and dispensing practices for Medi-Cal recipients.
View Summary (70 KB)
Updated Due Date Plus App available for expecting and new parents
April 21, 2020 – The latest version of Due Date Plus® is now available for download from the App Store® and Google Play™. We invite you to share this news with your patients in Los Angeles and San Diego counties who are expecting or are new parents.
Read about the app (78 KB)
Medi-Cal Bulletins Update
April 8, 2020 – Updates posted during Q1 2020 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (85 KB)
Formulary Changes
April 1, 2020 – The drug formularies on the Blue Shield of California Promise Health Plan website have been updated to reflect medications currently covered by Medi-Cal, Medicare, and Cal Medi-Connect. For your convenience, we’ve provided summaries of changes that were made during the past few months.
Medi-Cal Bulletins Update
March 31, 2020 – Updates posted during Q4 2019 by the Department of Health Care Services regarding important topics that may impact services provided for Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (79 KB)
Medi-Cal Bulletins Update
January 28, 2020 – Updates posted during 2019 by the Department of Health Care Services regarding important topics you need to know about when providing services to Blue Shield of California Promise Health Plan Medi-Cal members.
View Summary (100 KB)
Introducing the redesigned Provider Resources section
January 2, 2020 – You may notice a different "look and feel" to the format of the website, including the section we previously called "Provider Resources."
We have redesigned the Provider Resources section to improve navigation. You will continue to find forms, updates, program information, medical and medication policies here, but more easily. This part of the website does not require logging in, so you can access these resources at any time. You will see that a new landing page in the Providers section will allow you to quickly link to specific resources that are used often.
As we continue to enhance our website resources, we hope you will find our new format helpful. We encourage you to check this section periodically for new announcements.
News and announcements 2019
Medi-Cal Bulletins Update
October 14, 2019 – Updates posted by the Department of Health Care Services regarding important topics you need to know about when providing services to Blue Shield of California Promise Health Plan Medi-Cal members.
Read summary. (PDF, 84 KB)
APL 19-010
October 4, 2019 – Network provider update regarding this All Plan Letter 19-010 issued by the Department of Health Care Services regarding requirements to provide early and periodic screening, treatment, diagnostic and treatment services (EPSDT) to eligible members under the age of 21.
View notice (PDF, 145 KB)
Annual Quality Program Information
August 6, 2019 – General essential information related to quality programs that we send to our network participants annually to ensure awareness of resources.
Review annual summary (PDF, 86 KB)
Medi-Cal Quality Improvement Bulletin
Read this quarterly bulletin to learn about Blue Shield Promise quality program opportunities, provider and member incentives, and more.
Register for webinars
Sign up for upcoming webinars about working with Blue Shield Promise and our members.
Name change and data migration updates
Stay informed of updates and resources that support our new infrastructure since January 1, 2019.
Medi-Cal bulletin summaries
Review summaries of the latest bulletins posted by the Department of Health Care Services.
All Plan Letter summaries
See what guidelines and requirements have been posted in the latest Department of Health Care Services All Plan Letters (APLs).