Clinical policies and procedures
Use this searchable list to find Blue Shield of California Promise Health Plan clinical policies and procedures which can help you provide your patients with the highest standard of evidence-based medical care that is safe and effective. These policies are updated frequently.
Clinical policies and procedures
Prior authorization list
View the list of medical services and procedures requiring medical necessity review or supplemental documentation prior to payment.
Utilization management and clinical practice guidelines
Utilization management (UM) and 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.
Population Health Management
Our Disease Management Program provides education, care coordination, and support for members with certain chronic conditions.
Prior authorization and referral forms
Find common forms which you may need to request prior authorization, as well as patient referral forms.