Claims

Learn how to submit claims electronically, search our Claims Fee Schedule for Blue Shield allowances, find resources on provider appeals and adjustments, and learn more about submitting claims, rules for payment and claim status.

Claim tools  |  Manage electronic transactions  |  Facility and professional fee schedules  |  Claim issues and disputes  |  Policies and guidelines  |  Additional resources

 

Claim tools

Access our tools to check claims status and submit claims, and find mailing addresses, payment policies, fees and more.

How to submit claims

Learn how to submit claims to Blue Shield electronically.
 Clean claims submission tips (PDF, 24 KB)

Check claim status

Check on the status of a claim searching by member name, dates of service and more.

Claims routing tool

Find out where to submit your claims.

Submit claims via Office Ally

Submit, correct and resubmit claims and manage payments online using Office Ally.

Clear Claim Connection (C3)

Use our simulation tool to prescreen claims, view claim auditing rules, payment policies, and more.

 How to prescreen claims with C3 (PDF, 540 KB)

 Introduction to Clear Claim Connection (C3) (PDF, 816 KB)  

Submit via SympliSend

Upload first time paper claims with attachments and respond to itemization requests for claims in process.

 How to use SympliSend Portal (PDF, 1 MB)

 

Manage electronic transactions

Learn how to submit claims and receive payments using Electronic Data Interchange (EDI) for faster processing and payment.

Enroll in EDI

Enroll in EDI for your organization, either through a clearinghouse or directly with Blue Shield.

 How to get started with EDI

 EDI, EFT and ERA frequently asked questions

EDI companion guides

Access our companion guides for trading partners.

HIPAA 5010 and ICD-10 implementation

Read about changes to HIPAA standard transactions and codes.

Encounters resources

Learn about submission requirements, monthly performance summary reports and more.

 
Facility and professional fee schedules

Search the facility and professional fee schedules for Blue Shield of California providers and learn how we establish allowances.

About professional fee schedule

Learn how we establish allowances for professional services.

View facility fee schedules

Access outpatient facility fee schedules for ASCs and hospitals.

 

Claim issues and disputes

Submit provider disputes, check status, and view letters online. See for more information.

Provider disputes for Blue Shield of California Health Plan

Get details on the dispute filing process, including how to submit online or by mail.

 FAQs about submitting disputes online

Provider disputes for Blue Shield of California Promise Health Plan

Get details on the dispute filing process, including how to submit by mail.

View submitted disputes

Search disputes you've submitted online and by mail. You can also check status and view letters.

File a dispute by mail

Download the form and get instructions on how to submit your dispute.

Refund requests

Learn about overpayment refund procedures for Blue Shield of California providers.

No Surprise Billing Act

Begin an open negotiation to dispute a claim covered by this act. This is typically for out-of-network providers.

 

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 claim forms.

Ancillary claims filing

Review claim submission requirements for Blue Shield of California labs, specialty pharmacy and DME providers.

NCCI edits – physicians and hospitals outpatient

Learn about clinical coding edits for physicians & outpatient hospitals.

Payment policies and rules

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

Medications

View a list of Richman Injectables (high-cost, adult, childhood, etc.), Gene and Cell Therapy agents (including CAR-T) and Behavioral Health medications.

Special guidelines for claim forms

Find helpful guidelines for CMS 1500 and UB-04 claim forms.

National Drug Code requirements for physician administered drugs

Find requirements and drug list for encounters for Blue Shield Promise members.

 

Additional resources

Take advantage of educational resources and find important claim contacts.

Claims and billing tutorials

Find recorded webinars, eLearning, FAQs and "how to" guides.

Claims contacts

See phone numbers, addresses, and more.

© California Physicians' Service DBA Blue Shield of California 1999-2024. All rights reserved. California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.

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