Please Note:For your convenience, we now have a NEW dedicated provider line: (800) 468-9935.
EDI Inquiry. (Please note, this will take you to the Blue Shield of California Promise Health Plan Provider website.)
On January 1, 2019, Care1st changed its name to Blue Shield of California Promise Health Plan. We also moved member and provider data into new systems to better support our IT infrastructure. As a result of this name change and data migration, there have been many changes, some of which require action on your part over the next few months as we settle into our new processes.
This page will keep you informed with the latest updates.
Provider Login Assignment Form
You will have the ability to access Member Eligibility, Claims and Authorizations online with the login and password provided upon completion of the form. Understand that HIPAA requirements and guidelines should be adhered to and any discovery of mishap will be reported.
We Think the Same Way You Do.
Blue Shield of California Promise Health Plan is led by physicians with active practices in Southern California.
Here, you'll find a level of understanding and communication that helps both your practice and your patients. And since we're directed by doctors, we have a "patients first" philosophy of care.
Welcome to the Blue Shield of California Promise Health Plan Network
The Blue Shield of California Promise Health Plan network comprises over 7,000 physicians, 80 hospitals and many ancillary medical professionals. Our Provider Relations department develops and manages the Blue Shield of California Promise Health Plan provider network throughout our service areas. With our information systems, Internet accessibility and experienced management support, we strive to achieve optimal provider satisfaction.
Provider Relations understands the importance of developing and maintaining solid relationships with providers as well as the barriers that the under-served population face in accessing health care services. As a mixed-model HMO, Blue Shield of California Promise Health Plan contracts with individual physicians and Medical Groups/IPAs on a capitated basis. Under the Medical Group/IPA arrangements, many operational functions are delegated with Blue Shield of California Promise Health Plan providing oversight.
Working closely with you.
Our mixed model also offers an opportunity for independent physicians and other provider types to contract directly with Blue Shield of California Promise Health Plan under flexible reimbursement methodologies. It is our desire to be responsive and to work closely with our providers to better understand the challenges facing them. Our objective is to help providers improve the delivery of health care services.
Materials and Forms
Blue Shield of California Promise Health Plan Special Programs
Clinical Practice Guidelines Links
Nursing Facilities Reference Guide
The 2019 Nursing Facilities Reference Guide will be published shortly. If you have questions, please contact Long Term Care at (855) 622-2755, fax: (844) 200-0121.
SNF Transportation Request Form (San Diego)
Skilled Nursing Facilities please complete the forms in legibly and in their entirety.
All Information is necessary to arrange transport.
Physicians Certification Form – Request for Transportation
Access to Care Standards
Blue Shield of California Promise Health Plan uses guidelines to ensure that its members have access to care:
Initial Health Assessment (IHA)
QI Annual Evaluations/ Program Goals
Blue Shield of California Promise Health Plan administers a robust ongoing Quality Improvement Program with a goal to ensure that members receive the highest quality of care and services.
Medical Record Documentation Standards
Blue Shield of California Promise Health Plan’s goal is to assure each patient has a legible, detailed, well organized, confidentially stored, and easily retrievable medical record. These records need to be consistent with standard medical and professional practice and meet the standards of oversight organizations, including Blue Shield of California Promise Health Plan and regulatory agencies. Blue Shield of California Promise Health Plan recommends a six section format