Providers | Blue Shield of California Promise Health Plan

Provider Manual


Why You Need the Manual

Your Provider Manual specifically addresses the contractual and regulatory requirements of Blue Shield of California Promise Health Plan.
This manual is intended as a guideline for the provision of covered services to Blue Shield of California Promise Health Plan Members.
This manual contains policies, procedures and general reference information including minimum standards of care, which are required of Blue Shield of California Promise Health Plan Providers.
Following requirements defined in the manual ensures that our members receive comprehensive care.

We'll Keep You Updated

From time to time we will need to update our website as our policies change, or as L.A. Care, CMS, and/or DHS requirements change. We will keep you informed of those changes as they occur. As a Blue Shield of California Promise Health Plan Provider, we hope this information will help you better understand how Blue Shield of California Promise Health Plan operates.

Additional Information

Although this manual contains a comprehensive summary of Blue Shield of California Promise Health Plan policies and procedures, additional protocols regarding plan administrative practices, full plan medical policies, and other detailed information are available to the provider upon request by calling Blue Shield of California Promise Health Plan Provider Services Department at (800) 468-9935.


California Department of Health Care Services

Instructions related to Transactions based on ASC X12 Implementation Guides, version 004050.

Health Care Provider Directory (EDI 274)
Standard Companion Guide Transaction Information

Health Care Provider Directory Flat File Version for EDI 274
Flat File Version for EDI 274 Provider Information

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If you enter the web site of Krames on Demand (http://kod.staywellsolutionsonline.com/?accountId=0), please be aware that you will leave Blue Shield of California Health Plan's web site, and will be routed to the Krames on Demand's web site that adheres to the rules, policies, regulations and terms of use of that service.


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You are leaving Blue Shield of California Promise Health Plan's website

If you enter the web site https://ocrportal.hhs.gov, please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Office for Civil Rights web site that adheres to the rules, policies, regulations and terms of use of that agency. If you enter the web site http://www.hhs.gov, please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the U.S. Department of Health & Human Services web site that adheres to the rules, policies, regulations and terms of use of that agency. If you enter the web site of CMS (Centers for Medicare & Medicaid Services) (http://www.cms.gov), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the CMS's web site that adheres to the rules, policies, regulations and terms of use of that service. If you enter the web site https://www.ssa.gov/medicare/prescriptionhelp/, please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Medicare Prescription Drug Plan Costs web site that adheres to the rules, policies, regulations and terms of use of that service. If you enter the web site https://secure.ssa.gov/i1020/start, please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Official Website of the U.S. Social Security Administration that adheres to the rules, policies, regulations and terms of use of that agency. If you enter the web site of Beacon Health Strategies (beaconhealthstrategies.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Beacon Health Strategies web site that adheres to the rules, policies, regulations and terms of use of that service. If you enter the web site My Advocate (www.myadvocatehelps.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the My Advocate web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site American Specialty Health (ASH) (www.ashlink.com/ash/ashco.aspx?hp=Care1st), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the ASH web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Dental Providers (www.deltadentalins.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Dental Providers web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Hearing Services/ Hearing Aids (www.epichearing.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Hearing Services web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site VSP (www.vsp.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the VSP web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site KEPRO (www.keproqio.com), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the KEPRO web site that adheres to the rules, policies, regulations and terms of use of that service. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Livanta (www.bfccqioarea5.com ), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Livanta web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site U.S. Department of Health and Human Services (ocrportal.hhs.gov/ ), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the U.S. Department of Health and Human Services web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site CalDuals (http://calduals.org/ ), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the CalDuals web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site California Department of Health Care Services (https://www.dhcs.ca.gov/ ), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the California Department of Health Care Services web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site CMS (Centers for Medicare & Medicaid Services) (http://www.cms.gov), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the CMS (Centers for Medicare & Medicaid Services) web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site California Department of Health Care Services (DHCS) (https://www.healthcareoptions.dhcs.ca.gov/), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the California Department of Health Care Services (DHCS) web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Medi-Cal Dental Program (https://www.denti-cal.ca.gov/), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Medi-Cal Dental Program web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Solera4me (https://www.solera4me.com/bluepromisemedicare), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Solera4me web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site. If you enter the web site Department of Managed Healthcare (http://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForms.aspx), please be aware that you will leave Blue Shield of California Promise Health Plan's web site, and will be routed to the Department of Managed Healthcare web site that adheres to the rules, policies, regulations and terms of use of that Organization. Blue Shield of California Promise Health Plan makes no representation and is not responsible for the quality, content, nature, or reliability of any linked site.