In this section you will find these resources:
- Access to care standards
- All Plan Letter summaries
- Health assessment guidelines for Medi-Cal providers
- Healthcare fraud prevention guidelines
- Medical records documentation standards
- Medi-Cal bulletin summaries
- Physicians' site review policy and procedures
- Provider dispute policies and procedures
- Provider manuals (Medi-Cal Provider Manual and Nursing Facilities Reference Guide)
Commonly requested forms for prior authorizations, coverage determination requests, referrals, screenings, enrollment for electronic claims submission and remittance advices, and more are also available here.
Review and download provider manuals for Medi-Cal policies.
Learn the guidelines Blue Shield of California Promise Health Plan uses to ensure our members have proper access to care.
Learn how to conduct health assessments, find age-appropriate patient questionnaires and forms, and related provider training materials.
See policies for site accessibility, fire safety and prevention, non-medical emergency procedures, medical equipment maintenance, and staff qualification requirements.
Learn about the requirements and standards for Blue Shield Promise member medical records.
Communicate your questions and concerns to Blue Shield Promise and learn how to appeal or dispute a claim payment.
Learn how to report suspected healthcare fraud and find prevention tips and guidelines.
Find the forms you need for authorizations, referrals, service requests, EFT enrollment, and provider disputes.
Review summaries of the latest bulletins posted by the Department of Health Care Services.
See what guidelines and requirements have been posted in the latest Department of Health Care Services All Plan Letters (APLs).
Learn about our policies, procedures, and requirements for evaluating and applying new technologies, devices, and procedures for our Medical Care Solutions.
View summaries of guidelines and requirements posted in the latest All Plan Letters (APLs) related to the COVID-19 emergency.
Get details on payments for non-contracted ground emergency medical transport providers (GEMT) specified in All Plan Letter 20-004.
See how providers may qualify for additional payments allocated from Proposition 56 tax funds.
Access network provider tools on Provider Connection website.