Filing a dispute by mail
Find resources and information regarding filing provider disputes by mail, including dispute resolution forms and where to send them. You can also file most provider disputes online.
Blue Shield of California is committed to providing a fair and transparent Provider Dispute Resolution Process. However, the dispute process is not intended to address claim corrections, requests for claim information, or inquiries about claim decisions, procedures, and payment rules.
How to file a dispute by mail
Blue Shield of California healthcare providers can file disputes by printing, filling out, and mailing the appropriate provider dispute resolution form to the right address. Find forms and mailing addresses below.
A dispute submitted in writing must contain the following information:
- The provider's name
- The provider's identification number: The Blue Shield Identification number (PIN) or the provider's tax or Social Security number
- Contact information: Mailing address and phone number
- Blue Shield's Internal Control Number (ICN), when applicable
- The patient's name, when applicable
- The patient's Blue Shield subscriber number, when applicable
- The date of service, when applicable
- A clear explanation of issue the provider believes to be incorrect, including supporting medical records when applicable
- As applicable, bundled disputes must identify individually each item by using either the ICN or the section of the contract and sequential numbers that are cross-referenced to a document or spreadsheet
To learn about the dispute review process, go to the Dispute review process and guidelines page.
Dispute resolution forms
Download dispute resolution forms
- Blue Shield of California Provider dispute resolution – Facility (PDF, 72KB)
- Blue Shield of California Provider dispute resolution – Professional (PDF, 72 KB)
- Blue Shield of California Provider dispute resolution – Medicare (PDF, 195 KB)
- Blue Shield Promise Provider dispute resolution request form (PDF, 358 KB)
- Waiver of Liability form – Medicare (PDF, 9 KB)
Where to send dispute resolution forms
Initial disputes |
Submit initial disputes in writing to: Blue Shield Initial Dispute Resolution Office Submit disputes regarding facility contract exceptions in writing to: Blue Shield Initial Dispute Resolution Office |
| Final disputes | Submit final disputes in writing to: Blue Shield Final Provider Dispute and Resolution Office |
| For Medicare Advantage Plans | Submit disputes in writing to: Blue Shield Provider Dispute Resolution |
| For Blue Shield of California Promise Health Plans | Submit disputes regarding Blue Shield Promise plans in writing to: Blue Shield of California Promise Health Plan |
Claims-routing tool
Use our claims-routing tool to find out where to send your claims by mail.