CLINICAL POLICIES, PROCEDURES AND GUIDELINES

Learn about our policies, requirements, criteria for evaluating and applying new technologies, and procedures that comprise our medical care solutions:

  • Medical policies and guidelines
  • Medical care solutions
  • Prior authorization list
  • Prior authorization and referral forms
  • Pharmacy services information and drug formularies

Medical care solutions

Review medical care solutions for Blue Shield Promise plans.

View and search the list of all 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.

View prior authorization list

Clinical practice guidelines and shared decision-making aids

Clinical practice guidelines define healthcare standards applicable to members and providers.

Review clinical practice guidelines

Pharmacy services and drug formularies

Review drug formularies for Cal MediConnect and find pharmacy services information.

Find drug formularies

Policies, guidelines, standards and forms

Find provider manuals, provider dispute resolution policies, medical record, access to care standards, and more.

Review our policies, guidelines and standards Find forms

Prior authorization and referral forms

Find common forms which you may need to request prior authorization, as well as patient referral forms.

Find authorization request and referral forms

Provider Connection
Access network provider tools on Provider Connection website.

Access Provider Connection

Health Care Options: 1-844-580-7272, de lunes a viernes, de 8:00 a. m. - a 6:00 p. m. Los usuarios del sistema TTY deben llamar al 1-800-430-7077.

Para obtener información sobre Blue Shield Promise Cal MediConnect Plan y otras opciones de Cal MediConnect para la atención de su salud, comuníquese con el Department of Health Care Services (Departamento de Servicios de Atención de la Salud) al 1-800-430-4263 (TTY: 1-800-735-2922) o visite la página https://www.healthcareoptions.dhcs.ca.gov/.

Blue Shield of California Promise Health Plan es una organización de atención administrada que pertenece completamente a Blue Shield of California, y que ofrece Medi-Cal, Cal MediConnect, Medicare Advantage HMO y Dual Eligible Special Needs Plans (D-SNP, Planes de necesidades especiales con doble elegibilidad).

© 2002-2023. California Physicians’ Service DBA Blue Shield of California Promise Health Plan. Todos los derechos reservados.

California Physicians’ Service DBA Blue Shield of California Promise Health Plan es un licenciatario independiente de Blue Shield Association..

Blue Shield of California Promise Health Plan es un plan HMO y un plan HMO D-SNP que tiene un contrato con Medicare y un contrato con el Programa Medicaid del Estado de California. La inscripción en Blue Shield of California Promise Health Plan depende de la renovación del contrato.

Las redes de proveedores pueden cambiar en cualquier momento.

Blue Shield of California Promise Health Plan complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.

Blue Shield of California Promise Health Plan cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascedencial, religión, sexo, estado civil, genero, identidad de genero, orientación sexual, edad ni discapacidad.

Blue Shield of California Promise Health Plan 遵循適用的州法律和聯邦公民權利法律，並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻 狀況、性別認同、性取向、年齡或殘障為由而進行歧視。

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Blue Shield of California Promise Health Plan, 3840 Kilroy Airport Way, Long Beach, CA  90806

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