Policies and standards
Find information about standards for HIPAA transactions, medical records, medication and member data policies, as well as provider dispute regulations for Blue Shield of California and Blue Shield of California Promise Health Plan providers.
Medical policies and procedures
Learn about our medical policies, policy goals and our process for making coverage decisions.
Medication policy
Read about our medication policy for injectable and office-administered drugs.
Payment policies and rules
Read an overview of payment processing policies and rules.
HIPAA transaction standards
Read an explanation of HIPAA and patient medical records protection standards.
Medical record standards
Access Blue Shield's policy on medical record standards, generic forms to assist providers with documentation requirements and learn about recommended medical record format.
Member protected health information confidentiality and protection policy
Learn about Blue Shield's policy for sharing and disclosing private member data.
Claims and dispute resolution regulations
Review the DMHC regulations summary and a compliance overview.
Facility site review policy and procedures for Blue Shield Promise physicians
Find requirements for site accessibility, fire safety, emergency procedures, equipment maintenance and staff qualification.
Access to care standards for Blue Shield providers
Learn about guidelines Blue Shield uses to ensure our members have proper access to care.
Other payor summary list
View a list of other payors (employers, insurance companies, associations, etc.) with which Blue Shield holds contracts.