Payment policies and rules
Prescreen claims
Use the Clear Claim Connection (C3) simulation tool to test HCPCS/CPT codes and view clinical edits with rationales.
Payment processing codes
Refer to the following documents for Blue Shield's payment processing logic and procedure codes:
Blue Shield payment processing logic (PDF, 50 KB)
Hospital Acquired Condition (HAC)/Never Events Codes (Excel, 332 KB) Effective October 1, 2024 - September 30, 2025
Incidental procedure codes (PDF, 120 KB)
Office-based ambulatory procedure codes (PDF, 115 KB)
Payment policies
Claims resources
Ancillary claims filing guidelines
Review claim submission requirements for Blue Shield of California labs, specialty pharmacy and DME providers.
Special guidelines for claim forms
Special guidelines for CMS 1500 and UB-04 claims to help physicians submit these forms properly and process claims efficiently.
Enroll in EDI
Learn how to submit all of your claims and receive your payments electronically for faster processing and payment using electronic data interchange (EDI).
Professional fee schedule for Blue Shield of California providers
Search the professional fee schedule for Blue Shield of California allowances and learn how we establish them.
Claim issues and disputes
Submit provider disputes, check status, and view letters online.
National drug code requirements for physician administered drugs
Find requirements and drug list for claims and encounters for Promise Medi-Cal and Cal MediConnect members.