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Provider Connection help | Blue Shield of CA Provider

<!DOCTYPE HTML> <html lang="en" data-dir="ltr"> <head> <meta charset="UTF-8"/> <title>Provider Connection help | Blue Shield of CA Provider</title> <link href="/content/dam/bsca/en/bsc-brand/favicon/favicon.png" rel="shortcut icon" type="image/x-icon"/> <meta name="description" content="Find help in creating a Provider Connection account, viewing authorization status, working with claims, receiving messages, and more."/> <meta name="keywords" content=""/> <meta name="author" content="Blue Shield CA"/> <meta property="twitter:site" content="@BlueShieldCA"/> <meta property="twitter:creator" content="@BlueShieldCA"/> <meta property="twitter:title" content="Provider Connection help | Blue Shield of CA Provider"/> <meta property="og:image" content="/content/dam/bsca/en/bsc-brand/logos/twitter/pazMGY.png"/> <meta property="twitter:card" content="/content/dam/bsca/en/bsc-brand/logos/twitter/pazMGY.png"/> <meta property="twitter:description" content="Find help in creating a Provider Connection account, viewing authorization status, working with claims, receiving messages, and more."/> <meta property="og:type" content="Website"/> <meta property="og:site_name" content="BlueShieldCA"/> <meta property="og:title" content="Provider Connection help | Blue Shield of CA Provider"/> <meta property="og:description" content="Find help in creating a Provider Connection account, viewing authorization status, working with claims, receiving messages, and more."/> <meta property="og:url" content="https://www.blueshieldca.com/en/provider/about-pc/help"/> <meta name="template" content="base-page"/> <meta name="viewport" content="width=device-width, initial-scale=1"/> <link rel="canonical" href="https://www.blueshieldca.com/en/provider/about-pc/help"/> <link rel="stylesheet" href="/etc.clientlibs/bsca/clientlibs/clientlib-base.lc-1732168223965-lc.min.css" type="text/css"> <script src="/etc.clientlibs/clientlibs/granite/jquery.lc-1732168223965-lc.min.js"></script> <script src="/etc.clientlibs/clientlibs/granite/utils.lc-1732168223965-lc.min.js"></script> <input type="hidden" id="dl-page-name" value="Provider Connection help"/> <input type="hidden" id="dl-gen-site-section" value="Provider"/> <input type="hidden" id="dl-site-section" value="Provider : About Provider Connection"/> <input type="hidden" id="dl-sub-section" value="Provider : About Provider Connection : Provider Connection help"/> <script> window.dataLayer = window.dataLayer || []; window.dataLayer.push({ devEnvironment: window.location.hostname, 'page': { 'attributes': { 'language': document.getElementsByTagName('html')[0].getAttribute('lang'), 'responsiveDesignBreakpoint': screen.availWidth + ' X ' + screen.availHeight, 'screenOrientation': window.innerHeight > window.innerWidth ? 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height="0" width="0" style="display:none;visibility:hidden"></iframe> </noscript> <a href="#second" class="skip-link" onclick="skipnav()" style="display:none">skip to main content</a> <!-- End Google Tag Manager (noscript) --> <div class="root container responsivegrid"> <div id="container-87332716dc" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="inheritance experiencefragment aem-GridColumn aem-GridColumn--default--12"> <div class="xfpage page basicpage"> <div id="container-43bda9953e" class="cmp-container"> <div class="navigation"> </div> <div class="languagenavigation"> </div> <div class="stickynav"> <div class="responsivegrid cmp-container__fixed" data-component="stickynav"> <!-- <div class="headertopbar"> <div data-sly-resource="topbar"></div> </div> --> <div id="navbar"> <div class="header_top"> <div class="alerts"> <ul> </ul> </div> <link rel="stylesheet" href="/etc.clientlibs/bsca/components/content/sticyalertbar/clientlibs/site.lc-1732168223965-lc.min.css" type="text/css"> <script async defer src="/etc.clientlibs/bsca/components/content/sticyalertbar/clientlibs/site.lc-1732168223965-lc.min.js"></script> <div class="cmp-topbar__parent"> <nav aria-label="Top" class="cmp-topbar__navbarcontainer"> <ul class="menu-left"> <li> <div class="cmp-topbar__textincrease"> <div><div class="text" data-component="textincrease"> <button class="clickme increase" data-increasetext="Increase Text Size" gtm-track-click="{'eventCategory': 'Provider', 'eventAction': 'Click - Text Increase', 'eventLabel': 'Increase Text Size', 'eventNonInteracton': 'false', 'event': 'eventTracker'}">Increase Text Size</button> <button class="clickme decrease" data-decreasetext="Decrease Text Size" gtm-track-click="{'eventCategory': 'Provider', 'eventAction': 'Click - Text Decrease', 'eventLabel': 'Decrease Text Size', 'eventNonInteracton': 'false', 'event': 'eventTracker'}">Decrease Text Size</button> </div></div> </div> </li> </ul> <ul class="menu-right"> <li> <div class="cmp-topbar__login"> <div> </div> </div> </li> <li> <div class="cmp-topbar__Hlist"> <div> <div class="cmp-horizontallist custom-pipe-container float-right"> <ul> <li> <a href="/providerwebapp/logOutExternal" onclick='onHorizontalListClick(event);' gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '/providerwebapp/logOutExternal.html', 'eventLabel': 'Log out', 'eventNonInteracton': 'false', 'event': 'eventTracker'}">Log out</a> <span aria-hidden="true" class="pipe-spacing">|</span> </li> <li> <a href="/providerwebapp/accountManagement/providerPractitionerProfiles" onclick='onHorizontalListClick(event);' gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '/providerwebapp/accountManagement/providerPractitionerProfiles.html', 'eventLabel': 'Provider &amp; practitioner profiles', 'eventNonInteracton': 'false', 'event': 'eventTracker'}">Provider &amp; practitioner profiles</a> <span aria-hidden="true" class="pipe-spacing">|</span> </li> <li> <a href="/providerwebapp/message-center" onclick='onHorizontalListClick(event);' gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '/providerwebapp/message-center.html', 'eventLabel': 'Message center', 'eventNonInteracton': 'false', 'event': 'eventTracker'}">Message center</a> <span aria-hidden="true" class="pipe-spacing">|</span> </li> <li> <a href="/providerwebapp/accountManagement/homePage" onclick='onHorizontalListClick(event);' gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '/providerwebapp/accountManagement/homePage.html', 'eventLabel': 'Account management', 'eventNonInteracton': 'false', 'event': 'eventTracker'}">Account management</a> <span aria-hidden="true" class="pipe-spacing">|</span> </li> <li> <a href="/en/provider/about-pc/contact-us" onclick='onHorizontalListClick(event);' gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '/content/bsca/language-masters/en/provider/about-pc/contact-us.html', 'eventLabel': 'Contact us', 'eventNonInteracton': 'false', 'event': 'eventTracker'}">Contact us</a> <span aria-hidden="true" class="pipe-spacing">|</span> </li> <li> <a href="/en/provider/about-pc/help" onclick='onHorizontalListClick(event);' gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '/content/bsca/language-masters/en/provider/about-pc/help.html', 'eventLabel': 'Help', 'eventNonInteracton': 'false', 'event': 'eventTracker'}">Help</a> <span aria-hidden="true" class="pipe-spacing">|</span> </li> <li class="nopipe"> <a target="" title="" href="javascript:void(0);" id="uhp_header_feedback" oncontextmenu="return false;" class="anchor-links margin-T24 footerFeedbackToggle" gtm-track-click="{'eventCategory': 'Provider', 'eventAction': 'Navigation - Send Us Feedback', 'eventLabel': 'Feedback', 'eventNonInteracton': 'false', 'event': 'eventTracker'}">Feedback</a> </li> </ul> </div> <script> function onHorizontalListClick(e){ if(e.srcElement.hash) { var target = e.srcElement.hash.substring(1); var targetElement = document.getElementById(target); targetElement.href = "#"; targetElement.focus(); console.log("Focus", target, targetElement, document.activeElement); } } </script> </div> </div> </li> </ul> </nav> </div> <div class="cmp-header__parent"> <div class="trans">&nbsp;</div> <header class="cmp-header" data-component="header"> <div class="container responsivegrid cmp-container__fixed"> <div id="container-97c410ebe3" class="cmp-container"> <div class="header-logo__parent"> <div class="cmp-header--logo"> <div> <div class="image"> <div class="cmp-image"> <a href="/en/provider" data-auth-href="/providerwebapp/connect/home"> <img src="/content/dam/bsca/en/shared/logos/Blue-Shield-California-logo.svg" loading="lazy" class="cmp-image__image primarylogo" itemprop="contentUrl" alt="Blue Shield of California, homepage" title="Blue Shield of California, homepage"/> </a> <meta itemprop="caption" content="Blue Shield of California, homepage"/> </div> <div id="isSpoof" class="cmp-image cmp-image-secondary"> <a href="/en/provider" data-auth-href="/providerwebapp/connect/home"> <img src="/content/dam/bsca/en/shared/logos/provider-logo.png" loading="lazy" class="cmp-image__image secondarylogo" itemprop="contentUrl" alt="Provider Connection logo" title="Provider Connection logo"/> </a> <meta itemprop="caption" content="Provider Connection logo"/> </div> </div> </div> </div> </div> <div class="navigation"> <nav aria-label="Main" id="navigation-e10abc050c" class="cmp-navigation" itemscope="" itemtype="http://schema.org/SiteNavigationElement" data-cmp-data-layer="{&quot;navigation-e10abc050c&quot;:{&quot;@type&quot;:&quot;core-components-examples/components/navigation&quot;}}"> <ul class="cmp-navigation__group"> <li class="cmp-navigation__item cmp-navigation__item--level-0" data-title="Eligibility &amp; benefits"> <a data-cmp-clickable="false" class="cmp-navigation__item-link" data-href="javascript:void(0)" href="javascript:void(0)"> Eligibility &amp; benefits <span class="chevron-icon"></span> </a> <div class="content"> <ul class="single-column"> <li> <div class="heading "> <h4>Eligibility &amp; benefits </h4> <div class="heading_bdr">&nbsp;</div> </div> <ul> <li data-title="Eligibility &amp; benefits overview"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/eligibility-benefits.html" href="/en/provider/eligibility-benefits" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Eligibility &amp; benefits', 'eventLabel': 'Secondary: Eligibility &amp; benefits', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Eligibility &amp; benefits overview </a> </li> <li data-title="Verify eligibility"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/providerwebapp/verifyEligibility/singleSearch.html" href="/providerwebapp/verifyEligibility/singleSearch" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Eligibility &amp; benefits', 'eventLabel': 'Secondary: Eligibility &amp; benefits', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Verify eligibility </a> </li> </ul> </li> <li> <ul> <li data-title="Member rosters"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/providerwebapp/memberRosters.html" href="/providerwebapp/memberRosters" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Eligibility &amp; benefits', 'eventLabel': 'Secondary: ', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Member rosters </a> </li> <li data-title="Benefit summaries"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/eligibility-benefits#benefitsum" href="/en/provider/eligibility-benefits#benefitsum" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Eligibility &amp; benefits', 'eventLabel': 'Secondary: ', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Benefit summaries </a> </li> <li data-title="Preventive health guidelines"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/eligibility-benefits#phg" href="/en/provider/eligibility-benefits#phg" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Eligibility &amp; benefits', 'eventLabel': 'Secondary: ', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Preventive health guidelines </a> </li> </ul> </li> <li> <div class="heading "> <h4> </h4> </div> </li> </ul> </div> </li> <li class="cmp-navigation__item cmp-navigation__item--level-0" data-title="Authorizations"> <a data-cmp-clickable="false" class="cmp-navigation__item-link" data-href="javascript:void(0)" href="javascript:void(0)"> Authorizations <span class="chevron-icon"></span> </a> <div class="content"> <ul class="single-column"> <li> <div class="heading "> <h4>Authorizations </h4> <div class="heading_bdr">&nbsp;</div> </div> <ul> <li data-title="Authorizations overview"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/authorizations.html" href="/en/provider/authorizations" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Authorizations', 'eventLabel': 'Secondary: Authorizations', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Authorizations overview </a> </li> <li data-title="Medical authorization"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/providerwebapp/authorization/medicalAuthorization.html" href="/providerwebapp/authorization/medicalAuthorization" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Authorizations', 'eventLabel': 'Secondary: Authorizations', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Medical authorization </a> </li> <li data-title="Medical authorization status"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/providerwebapp/authorization/medicalRequestStatus.html" href="/providerwebapp/authorization/medicalRequestStatus" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Authorizations', 'eventLabel': 'Secondary: Authorizations', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Medical authorization status </a> </li> <li data-title="Pharmacy authorization"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/providerwebapp/authorization/pharmacyAuthorization.html" href="/providerwebapp/authorization/pharmacyAuthorization" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Authorizations', 'eventLabel': 'Secondary: Authorizations', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Pharmacy authorization </a> </li> </ul> </li> <li> <ul> <li data-title="Pharmacy authorization status"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/providerwebapp/authorization/pharmacyRequestStatus.html" href="/providerwebapp/authorization/pharmacyRequestStatus" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Authorizations', 'eventLabel': 'Secondary: ', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Pharmacy authorization status </a> </li> <li data-title="Out-of-area Blue plan members"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/authorizations#otherblue" href="/en/provider/authorizations#otherblue" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Authorizations', 'eventLabel': 'Secondary: ', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Out-of-area Blue plan members </a> </li> <li data-title="Policies &amp; guidelines"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/authorizations#policies" href="/en/provider/authorizations#policies" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Authorizations', 'eventLabel': 'Secondary: ', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Policies &amp; guidelines </a> </li> <li data-title="Authorization forms &amp; list"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/authorizations#forms" href="/en/provider/authorizations#forms" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Authorizations', 'eventLabel': 'Secondary: ', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Authorization forms &amp; list </a> </li> <li data-title="Authorization log upload"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/providerwebapp/authorization/IPAFileUpload.html" href="/providerwebapp/authorization/IPAFileUpload" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Authorizations', 'eventLabel': 'Secondary: ', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Authorization log upload </a> </li> </ul> </li> <li> <div class="heading "> <h4> </h4> </div> </li> </ul> </div> </li> <li class="cmp-navigation__item cmp-navigation__item--level-0" data-title="Claims"> <a data-cmp-clickable="false" class="cmp-navigation__item-link" data-href="javascript:void(0)" href="javascript:void(0)"> Claims <span class="chevron-icon"></span> </a> <div class="content"> <ul class="single-column"> <li> <div class="heading "> <h4>Claims </h4> <div class="heading_bdr">&nbsp;</div> </div> <ul> <li data-title="Claims overview"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/claims.html" href="/en/provider/claims" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Claims', 'eventLabel': 'Secondary: Claims', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Claims overview </a> </li> <li data-title="How to submit claims"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/claims/how-to-submit.html" href="/en/provider/claims/how-to-submit" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Claims', 'eventLabel': 'Secondary: Claims', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> How to submit claims </a> </li> <li data-title="Claims routing tool"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/providerwebapp/connect/connect/claims/claimsRoutingTool.html" href="/providerwebapp/connect/connect/claims/claimsRoutingTool" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Claims', 'eventLabel': 'Secondary: Claims', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Claims routing tool </a> </li> <li data-title="Check claims status"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/providerwebapp/claims/claimStatus.html" href="/providerwebapp/claims/claimStatus" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Claims', 'eventLabel': 'Secondary: Claims', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Check claims status </a> </li> </ul> </li> <li> <ul> <li data-title="Real-time claims"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/providerwebapp/claims/realTimeClaims.html" href="/providerwebapp/claims/realTimeClaims" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Claims', 'eventLabel': 'Secondary: ', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Real-time claims </a> </li> <li data-title="Manage electronic transactions"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/claims/electronic-transactions.html" href="/en/provider/claims/electronic-transactions" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Claims', 'eventLabel': 'Secondary: ', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Manage electronic transactions </a> </li> <li data-title="Fee schedule"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/claims#profee" href="/en/provider/claims#profee" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Claims', 'eventLabel': 'Secondary: ', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Fee schedule </a> </li> <li data-title="Claims issues &amp; disputes"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/claims/disputes.html" href="/en/provider/claims/disputes" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Claims', 'eventLabel': 'Secondary: ', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Claims issues &amp; disputes </a> </li> <li data-title="Policies &amp; guidelines"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/claims#policies" href="/en/provider/claims#policies" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Claims', 'eventLabel': 'Secondary: ', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Policies &amp; guidelines </a> </li> </ul> </li> <li> <div class="heading "> <h4> </h4> </div> </li> </ul> </div> </li> <li class="cmp-navigation__item cmp-navigation__item--level-0" data-title="Guidelines &amp; resources"> <a data-cmp-clickable="false" class="cmp-navigation__item-link" data-href="javascript:void(0)" href="javascript:void(0)"> Guidelines &amp; resources <span class="chevron-icon"></span> </a> <div class="content"> <ul class="single-column"> <li> <div class="heading "> <h4>Guidelines &amp; resources </h4> <div class="heading_bdr">&nbsp;</div> </div> <ul> <li data-title="Guidelines &amp; resources overview"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/guidelines-resources.html" href="/en/provider/guidelines-resources" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Guidelines &amp; resources', 'eventLabel': 'Secondary: Guidelines &amp; resources', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Guidelines &amp; resources overview </a> </li> <li data-title="Forms"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/guidelines-resources#forms" href="/en/provider/guidelines-resources#forms" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Guidelines &amp; resources', 'eventLabel': 'Secondary: Guidelines &amp; resources', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Forms </a> </li> <li data-title="Drugs &amp; pharmacy resources"> <a data-cmp-clickable="true" class="cmp-navigation__item-link button arrowleft" data-href="/content/bsca/language-masters/en/provider/guidelines-resources#drugs" href="/en/provider/guidelines-resources#drugs" gtm-track-click="{ 'eventCategory': 'Navigation', 'eventAction': 'Guidelines &amp; resources', 'eventLabel': 'Secondary: Guidelines &amp; resources', 'eventNonInteracton': 'false', 'event': 'eventTracker'}"> Drugs &amp; pharmacy resources </a> </li> </ul> </li> <li> <ul> <li data-title="Guidelines &amp; standards"> <a data-cmp-clickable="true" 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cmp-spacer__desktop cmp-spacer__horizontal cmp-spacer__16"></div> <div class="cmp-spacer cmp-spacer__mobile cmp-spacer__horizontal cmp-spacer__8"></div> </div> <div class="title text-center aem-GridColumn aem-GridColumn--default--12"> <div id="title-18bc2d6742" class="cmp-title"> <h1 class="cmp-text__H1">Provider Connection help</h1> </div> </div> <div class="spacer aem-GridColumn aem-GridColumn--default--12"> <div class="cmp-spacer cmp-spacer__desktop cmp-spacer__horizontal cmp-spacer__32"></div> <div class="cmp-spacer cmp-spacer__mobile cmp-spacer__horizontal cmp-spacer__16"></div> </div> <div class="text narrow-text aem-GridColumn aem-GridColumn--default--12"> <div id="text-aff6e34779" class="rte-content cmp-text "> <h3><a id="top"></a>&nbsp;</h3> <h3><span class="cmp-text__bodytext">Find help in creating a Provider Connection account, viewing authorization status, working with claims, receiving messages, and more.</span><br> </h3> <p><span class="cmp-text__bodytext"><a href="#eligibility">Eligibility and benefits</a>&nbsp; |&nbsp; <a href="#claims">Claims</a>&nbsp; |&nbsp; <a href="#authorizations">Authorizations</a>&nbsp; |&nbsp; <a href="#manage-your-pc">Managing your Provider Connection account</a>&nbsp; |&nbsp; <a href="#for-acct-mgrs">For account managers</a>&nbsp; |&nbsp; <a href="#tech-issues">Technical issues</a></span></p> </div> <script async defer src="/etc.clientlibs/bsca/components/common/text/clientlibs.lc-1732168223965-lc.min.js"></script> </div> <div class="text narrow-text aem-GridColumn aem-GridColumn--default--12"> <div id="text-b00bfd6775" class="rte-content cmp-text "> <h2><a id="eligibility"></a><br> Eligibility and benefits<br> </h2> <h3>Verifying eligibility and benefits for a single member</h3> <p><span class="cmp-text__bodytext">Select the Search single member tab on the&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/verifyEligibility/singleSearch" title="Verify eligibility page">verify eligibility page</a>&nbsp;to determine eligibility and benefits for one Blue Shield of California/Promise Health Plan, other Blue plan, or Federal Employee Program member at a time.<br> &nbsp;</span></p> <p><span class="cmp-text__bodytextdark">To search for a Blue Shield of California or Promise Health Plan member:</span></p> <ol> <li><span class="cmp-text__bodytext">Choose 'Blue Shield of California / Promise Health Plan' as the card type.&nbsp;</span></li> <li><span class="cmp-text__bodytext">There are three options for the next step:&nbsp;</span><ul> <li><span class="cmp-text__bodytext">Search by the subscriber ID (9-16 alphanumeric characters) or&nbsp;</span></li> <li><span class="cmp-text__bodytext">Search by the member's last name, first name, and date of birth or&nbsp;</span></li> <li><span class="cmp-text__bodytext">Search by the member’s Social security number, Medicare beneficiary number, or Client index number.&nbsp;</span></li> </ul> </li> <li><span class="cmp-text__bodytext">When you’ve completed steps 1 and 2, click Search.&nbsp;</span></li> </ol> <p><span class="cmp-text__bodytextdark">Note:</span><span class="cmp-text__bodytext">&nbsp;Blue Shield of California subscriber eligibility and benefit information is available for up to 24 months before today’s date and one year before a member’s termination. Eligibility information is updated daily.&nbsp;<br> &nbsp;</span></p> <p><span class="cmp-text__bodytext">To search for other Blue plan or Federal Employee Program (FEP) members:</span></p> <ol> <li><span class="cmp-text__bodytext">Choose the member coverage or card type.</span></li> <li><span class="cmp-text__bodytext">Select the member type. The subscriber is the primary member. A dependent is any family member covered by the subscriber’s plan.</span></li> <li><span class="cmp-text__bodytext">For the subscriber, enter the Member ID (9-20 alphanumeric characters), last name, first name, birth date, gender, and eligibility/service date. For dependents, you must also enter the Subscriber last name.</span></li> <li><span class="cmp-text__bodytext">Choose your National Provider Identifier (NPI) from the drop-down list. If your NPI is not listed, select NPI not listed, then add your NPI.</span></li> <li><span class="cmp-text__bodytext">Choose the Service category and Service type to request specific benefit information.</span></li> <li><span class="cmp-text__bodytext">Click Search.<br> </span></li> </ol> <p><span class="cmp-text__bodytextdark">Tips:</span></p> <ul> <li><span class="cmp-text__bodytext">All search fields are required.</span></li> <li><span class="cmp-text__bodytext">You can identify an FEP member by the ID prefix R00 to R99.</span></li> <li><span class="cmp-text__bodytext">Searching other Blue plans and FEP member eligibility involves multiple database queries and may take more time. Once the search is complete, results will be presented on the page and/or in the message center.</span></li> <li><span class="cmp-text__bodytext">Other Blue plan and FEP member information is provided by the member’s home plan. The home plan is responsible for the quality and availability of the information.</span></li> </ul> </div> </div> <div class="text narrow-text aem-GridColumn aem-GridColumn--default--12"> <div id="text-5fa77893f4" class="rte-content cmp-text "> <h3>Snapshot of a single member’s eligibility<span class="cmp-text__bodytext"><br> </span></h3> <p><span class="cmp-text__bodytext">When you conduct a search to verify a single member’s eligibility, the search results provide a snapshot of the member’s eligibility information. This information also appears in the member’s eligibility details.</span><br> &nbsp;</p> <p><span class="cmp-text__bodytextdark">A Blue Shield of California member’s eligibility snapshot includes:</span></p> <ul> <li><span class="cmp-text__bodytext">Member name</span></li> <li><span class="cmp-text__bodytext">Subscriber ID</span></li> <li><span class="cmp-text__bodytext">Eligibility status based on current medical coverage.</span></li> <li><span class="cmp-text__bodytext">Basic member information: Birth date, gender, and residence address</span></li> <li><span class="cmp-text__bodytext">Coverage information: Plan name, plan type, coverage start and end date, Relationship to subscriber, and subscriber name</span></li> <li><span class="cmp-text__bodytext">PCP name</span></li> <li><span class="cmp-text__bodytext">In-network office visit copay information</span></li> <li><span class="cmp-text__bodytext">Links to member details, ID card, benefits, and claims<br> &nbsp;</span></li> </ul> <p><span class="cmp-text__bodytextdark">A Promise Health Plan member’s eligibility snapshot includes:</span><span class="cmp-text__bodytext"><br> </span></p> <ul> <li><span class="cmp-text__bodytext">Member name</span></li> <li><span class="cmp-text__bodytext">Subscriber ID</span></li> <li><span class="cmp-text__bodytext">Eligibility status based on current medical coverage.</span></li> <li><span class="cmp-text__bodytext">Basic member information: Birth date, gender, and residence address</span></li> <li><span class="cmp-text__bodytext">Coverage information: plan name, coverage effective date, redetermination date, relationship to subscriber, and subscriber name.&nbsp;</span></li> <li><span class="cmp-text__bodytext">PCP name and participating provider group information</span></li> <li><span class="cmp-text__bodytext">Medicare beneficiary ID and/or client index number, as applicable&nbsp;</span></li> <li><span class="cmp-text__bodytext">Links to member details, ID card, benefits, and claims</span><ul> <li><span class="cmp-text__bodytext">Note: If a member doesn’t have current coverage, future-plan information is displayed. If a member has neither current nor future coverage, the latest past plan information is displayed.<br> </span>&nbsp;</li> </ul> </li> </ul> <p><span class="cmp-text__bodytextdark">Other Blue plan or Federal Employee Program member’s eligibility snapshot includes:</span></p> <ul> <li><span class="cmp-text__bodytext">Member name</span></li> <li><span class="cmp-text__bodytext">Member ID</span></li> <li><span class="cmp-text__bodytext">Eligibility status based on current medical coverage.</span></li> <li><span class="cmp-text__bodytext">Basic member information: Birth date, gender, and residence address</span></li> <li><span class="cmp-text__bodytext">Plan type, coverage period, and relationship to subscriber</span></li> <li><span class="cmp-text__bodytext">Links to member details, benefits, and deductibles/out-of-pocket maximums information<br> &nbsp;</span></li> </ul> <h3>Verifying eligibility and benefits for multiple Blue Shield of California and Promise Health Plan members</h3> <p><span class="cmp-text__bodytext">You can search for eligibility and benefits information for up to 10 Blue Shield of California or Promise Health Plan members at a time.&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/verifyEligibility/singleSearch">Select the Search multiple members tab</a>&nbsp;on the erify eligibility page. (Multiple search is not available for other Blue plan and FEP members.)</span></p> <p><span class="cmp-text__bodytext">To search for multiple members:</span></p> <ol> <li><span class="cmp-text__bodytext">Enter the Member IDs (9–16 alphanumeric characters) for up to 10 members. Examples:</span><ul> <li><span class="cmp-text__bodytext">XEA123456789,</span></li> <li><span class="cmp-text__bodytext">J12345678,</span></li> <li><span class="cmp-text__bodytext">123456789</span></li> </ul> </li> <li><span class="cmp-text__bodytext">Click Search.</span></li> </ol> <p><span class="cmp-text__bodytext">To delete subscriber ID entries individually, click on the eraser icon next to each field. Or you can click Clear form to clear all fields.</span></p> <ul> <li><span class="cmp-text__bodytext">Search results for multiple Blue Shield of California members include the member’s name, birth date, member ID, relation to subscriber, and links to member eligibility details and claims. Benefit information is available from the details page.</span></li> <li><span class="cmp-text__bodytext">Search results for multiple Promise Health Plan members include the member’s name, birth date, member ID, line of business (LOB), and links to member eligibility details and claims. Benefit information is available from the details page.</span></li> </ul> <p><span class="cmp-text__bodytext">Note:&nbsp;Blue Shield of California subscriber eligibility and benefit information is available for up to 24 months before today’s date and one year before a member’s termination. Eligibility information is updated daily.<br> </span>&nbsp;</p> <h3>Member eligibility details (Blue Shield of California and Promise Health Plan members)</h3> <p><span class="cmp-text__bodytext">You can access Blue Shield of California and Promise Health Plan member eligibility details by clicking on the member’s name or the Details link in the search results for single or multiple members.<br> &nbsp;</span></p> <p><span class="cmp-text__bodytext">Member eligibility details contain:</span></p> <ul> <li><span class="cmp-text__bodytext">Member eligibility snapshot, including subscriber ID and eligibility status.</span></li> <li><span class="cmp-text__bodytext">Member information (phone number, preferred language, Subscriber dues information for Blue Shield of California members or Federal or state ID number and AID CD/group information for Promise Health Plan members).</span></li> <li><span class="cmp-text__bodytext">PCP and IPA/physician group details displaying current, future, and past PCP and physician group information (address, phone number, coverage period, and provider/group ID).</span></li> <li><span class="cmp-text__bodytext">Coverage details displaying information for current, future, and past medical coverage for up to 24 months from current date. Coverage details for Blue Shield of California members include coverage effective period, plan name, group number, and employer name. Coverage details for Promise Health Plan members include coverage effective period, plan line of business (LOB), and AID CD/group.</span></li> <li><span class="cmp-text__bodytext">Deductibles and out-of-pocket maximums are displayed for Ccrrent, future, and past coverage.&nbsp;<br> </span>&nbsp;</li> </ul> <h3>Deductible and out-of-pocket maximum details</h3> <p><span class="cmp-text__bodytext">The deductible and out-of-pocket maximum details show accumulative and current deductible and out-of-pocket information.</span></p> <ul> <li><span class="cmp-text__bodytext">The deductible amount is the initial amount members must pay in a calendar year (January 1 through December 31) for certain covered services before they become eligible to receive certain benefits.</span></li> <li><span class="cmp-text__bodytext">The out-of-pocket maximum amount is the total amount that a member has to pay in out-of-pocket expenses for covered services received during any calendar year of coverage.&nbsp;</span></li> <li><span class="cmp-text__bodytext">The Visits accumulator tracks the number of chiropractic, acupuncture, and O/P PT, RT, OT and chiro combined visits that a member has total in their plan year, the number used so far, and the number they have available. Note: this is not applicable for Promise member<br> </span>&nbsp;</li> </ul> <h3>Benefit details</h3> <p><span class="cmp-text__bodytext">To see benefit information for Blue Shield of California and Promise Health Plan members, search for the member, then select the benefits icon. Benefits information on Provider Connection is formatted to reflect the member’s <i>Evidence of coverage</i>. Find more information about benefits and services for a member’s plan in section 4 of the&nbsp;<a href="/en/bsp/medi-cal-members/plan-documents/member-handbook-evidence-of-coverage">Medi-Cal <i>Evidence of Coverage </i>(EOC)</a>.</span></p> <p><span class="cmp-text__bodytext">Note:&nbsp;You may view current or historical benefits-coverage data by selecting a time period from the coverage period drop-down.</span><br> &nbsp;</p> <h3>Member rosters</h3> <p><span class="cmp-text__bodytext">This page offers access to the most up-to-date roster of members who have chosen you as their primary care physician (PCP) or medical group.</span></p> <ul> <li><span class="cmp-text__bodytext">Search the roster based on practice or provider name. You can also filter by provider name, provider address, PIN, or IPA/medical group.&nbsp;</span></li> <li><span class="cmp-text__bodytext">Sort by status using the arrow next to the column header.&nbsp;</span></li> <li><span class="cmp-text__bodytext">Click the Export icon to download a single roster type.</span></li> <li><span class="cmp-text__bodytext">See which members are new or whose status has changed in the last 30 days.</span></li> <li><span class="cmp-text__bodytext">View a breakdown of the member roster by attribution status (active, new, disenrolled, redetermined, and on-hold). &nbsp;Click on the count under each status for a detailed member list that can be downloaded and saved to your computer.</span></li> </ul> </div> </div> <div class="secondarylink aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--6 aem-GridColumn--offset--default--3"> <a class="button " href="#top" gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '#top', 'eventLabel': 'return to top', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" target="_self">return to top</a></div> <div class="spacer aem-GridColumn aem-GridColumn--default--12"> <div class="cmp-spacer cmp-spacer__desktop cmp-spacer__horizontal cmp-spacer__16"></div> <div class="cmp-spacer cmp-spacer__mobile cmp-spacer__horizontal cmp-spacer__8"></div> </div> <div class="text narrow-text aem-GridColumn aem-GridColumn--default--12"> <div id="text-8bbbeefdb7" class="rte-content cmp-text "> <h2><a id="claims"></a>&nbsp;</h2> <h2>Claims</h2> <h3>Searching claims</h3> <h3><span class="cmp-text__bodytext">Providers can&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/claims/claimStatus" title="Search for claims">search&nbsp;for&nbsp;claims</a><span style="font-family: ProximaNova-Regular; font-weight: 400;">&nbsp;</span></span><span style="font-family: ProximaNova-Regular; font-weight: 400;"><span class="cmp-text__bodytextdark">submitted for Blue Shield of California, Promise Health Plan, other Blue plan (including BlueCard), and Federal Employee Program (FEP) members.</span></span></h3> <p><span class="cmp-text__bodytext">When you visit the&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/claims/claimStatus" title="Claim status search page">Claim&nbsp;status&nbsp;search&nbsp;page</a>, the 1,000 most recent claims load automatically. Then you can filter and search for specific claims.</span></p> <h4><span class="cmp-text__bodytextdark">Filtering, sorting, and exporting</span></h4> <ul> <li><span class="cmp-text__bodytext">Narrow your list of claims by number, member, or provider information.</span></li> <li><span class="cmp-text__bodytext">Sort by column headings such as member name, provider name, date of service, or ID Number.</span></li> <li><span class="cmp-text__bodytext">BlueCard claims are indicated by the BlueCard icon.&nbsp;<img src="https://www.blueshieldca.com/content/dam/bsca/en/provider/images/BlueCard-new-large.svg" alt="BlueCard" width="70" title="BlueCard">&nbsp;</span></li> <li><span class="cmp-text__bodytext">See up to 5,000 records at a time by exporting the list.</span><ul> <li><span class="cmp-text__bodytext">Select Export, then a spreadsheet will download to your computer.</span></li> <li><span class="cmp-text__bodytext">The exported spreadsheet detailed information on each claim.<br> <br> &nbsp;</span></li> </ul> </li> </ul> <h3><span class="cmp-text__bodytextdark">Claims list</span></h3> <ul> <li><span class="cmp-text__bodytext">Click on a column header to sort by that column.</span></li> <li><span class="cmp-text__bodytext">Click on a claim number to see its details, including service and claim notes.</span></li> <li><span class="cmp-text__bodytext">Payment decisions are explained in the claim notes and on the EOB.</span></li> <li><span class="cmp-text__bodytext">Click View EOB to see an EOB for a claim.</span></li> <li><span class="cmp-text__bodytext">Click the claim’s EFT number to see information about all claims paid by that transaction.<br> <br> &nbsp;</span></li> </ul> <h3>Downloading EOBs</h3> <p><span class="cmp-text__bodytext">To locate an EOB,&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/claims/claimStatus" title="Check claim status">go&nbsp;to&nbsp;the&nbsp;Check&nbsp;claim&nbsp;status&nbsp;page.</a>&nbsp;Click View EOB for any of the claims listed. You can also download EOBs from the Claims detail page.<br> &nbsp;</span></p> <h3>Viewing claim information</h3> <p><span class="cmp-text__bodytextdark">In the claim page header, you will see the status:</span><span class="cmp-text__bodytext">&nbsp;finalized or in process. For finalized claims, you can download EOB or perform other actions:&nbsp;</span></p> <ul> <li><span class="cmp-text__bodytextdark">Attach supporting documents*</span>&nbsp;<ul> <li><span class="cmp-text__bodytext">Upload up to 20 documents, PDF, DOC or XLS, up to 50 MBs (for most claims) and provide a description for your submission.&nbsp;</span></li> <li><span class="cmp-text__bodytext">See the confirmation number generated once you submit.&nbsp;</span></li> <li><span class="cmp-text__bodytext">View a list of documents you uploaded&nbsp;<br> &nbsp;</span></li> </ul> </li> <li><span class="cmp-text__bodytextdark">Resolve claim issue or dispute a claim</span>&nbsp;<ul> <li><span class="cmp-text__bodytext">Initiate a dispute online for a Commercial, Shared Advantage or BlueCard claim.</span></li> </ul> </li> </ul> <p><span class="cmp-text__smallcopy">*After a claim has been paid in full, the link to Attach supporting documents will disappear.</span><span class="cmp-text__bodytext"><span class="cmp-text__smallcopy"><br> &nbsp;</span></span></p> <h4><span class="cmp-text__bodytextdark">Summary and full view</span></h4> <ul> <li><span class="cmp-text__bodytext">See all claims associated with the member for the claim you’re viewing under member information.&nbsp;</span></li> <li><span class="cmp-text__bodytext">View the status history of adjusted claims, including dates they’ve been received and finalized, billed and paid amounts, and more.&nbsp;</span></li> <li><span class="cmp-text__bodytext">Review additional claims that may be relevant based on member ID, the provider, dates of service, and the amount billed.&nbsp;</span></li> <li><span class="cmp-text__bodytext">Get a summary view of the member information and claim details sections. Expand the sections by clicking Full view.&nbsp;</span></li> </ul> <p><span class="cmp-text__bodytext">&nbsp;</span></p> <h4><span class="cmp-text__bodytextdark">Payment details</span></h4> <ul> <li><span class="cmp-text__bodytext">Link to Check/EFT number details &nbsp;</span></li> <li><span class="cmp-text__bodytext">See all claims paid by check or Electronic fund transfer (EFT).&nbsp;</span></li> <li><span class="cmp-text__bodytext">View the payee's name and address where the paper checks were mailed.</span></li> </ul> <p><span class="cmp-text__bodytext">&nbsp;</span></p> <h4><span class="cmp-text__bodytextdark">Claim history</span></h4> <p><span class="cmp-text__bodytext">Track a claim through the adjustment process. You may also see related claims if you have multiple claims for the same member and date of service.&nbsp;<br> &nbsp;</span></p> <h4><span class="cmp-text__bodytextdark">Uploaded documents&nbsp;</span></h4> <p><span class="cmp-text__bodytext">View a list of documents for this claim what were uploaded online through Provider Connection.<br> &nbsp;</span></p> <h4><span class="cmp-text__bodytextdark">For BlueCard claims</span></h4> <ul> <li><span class="cmp-text__bodytext">Follow the status of the claims as they are sent to out-of-state Blue plans for processing and returned to Blue Shield of California. For example, claims sent to out-of-state Blue plans show the status, In-process with out-of-state Blue plan.&nbsp;</span></li> <li><span class="cmp-text__bodytext">Request status, eligibility, and benefits information from out-of-state plans directly from the claims page. &nbsp;</span></li> <li><span class="cmp-text__bodytext">View available letters linked in BlueCard claim header</span></li> </ul> <p><span class="cmp-text__bodytext">&nbsp;</span></p> <h3><span class="cmp-text__bodytext">Finding EOBs by amount paid or amount billed</span></h3> <p><span class="cmp-text__bodytext">To locate an EOB by amount,&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/claims/claimStatus" title="Check claim status">go&nbsp;to&nbsp;the&nbsp;Check&nbsp;claim&nbsp;status&nbsp;page</a>. Select the Amount paid drop down. Then choose to filter by the amount paid or the amount billed.<br> &nbsp;</span></p> <h3><span class="cmp-text__bodytext">Finding claims by check or EFT number</span></h3> <p><span class="cmp-text__bodytext">To find a claim by check or EFT number,&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/claims/claimStatus" title="Check claim status">go&nbsp;to&nbsp;the&nbsp;Check&nbsp;claim&nbsp;status&nbsp;page</a>. Search for a check or EFT number using those entry fields<br> &nbsp;</span></p> <h3>Claims-routing tool</h3> <p><span class="cmp-text__bodytext">To find out where you should send a BlueCard claim, enter the three-character prefix and the date of service into the&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/connect/connect/claims/claimsRoutingTool" title="Claims-routing tool">claims-routing&nbsp;tool</a>.</span></p> <p><span class="cmp-text__bodytext">The three-character prefix precedes a Blue Cross or Blue Shield member’s identification number. This prefix identifies the member’s home plan and where to address claims.</span></p> <p><span class="cmp-text__bodytext">The date of service is the month, day, and year a Blue Cross or Blue Shield member received medical services from the provider.<br> &nbsp;</span></p> <h3>Prescreen claims with Clear Claim Connection (C3)</h3> <p><span class="cmp-text__bodytext"><a href="https://www.blueshieldca.com/providerwebapp/claims/preScreenClaims" title="Clear Claim Connection">Clear&nbsp;Claim&nbsp;Connection&nbsp;(C3)</a>&nbsp;is a simulation tool that gives providers a view into the claim-auditing rules, payment policies, and clinical rationales of Blue Shield of California’s claims processing. C3 does not submit claims to Blue Shield and is not a guarantee of member eligibility or claim payment. It is a tool used to test codes on mock claims and reference their rationales from nationally recognized sources.</span></p> <p><span class="cmp-text__bodytext">Providers can enter CPT and HCPCS coding scenarios and immediately view the audit result. By prescreening claims, you will minimize your administrative costs and simplify doing business with us.<br> &nbsp;</span></p> <h3>Dispute a claim decision online</h3> <p><span class="cmp-text__bodytext">There are two ways to initiate an online dispute:&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/#/claims/claimStatus" title="Search for a claim">Search for a claim</a>, then from the Claim page, click the “Resolve claim issue or dispute” link in the header. Or you can go to the&nbsp;<a href="/en/provider/claims/disputes">Claim issues and disputes</a>&nbsp;page and enter a claim number there.<br> &nbsp;</span></p> <h4><span class="cmp-text__bodytextdark">To complete your submission:</span></h4> <p><span class="cmp-text__bodytextdark"><i>Step 1: &nbsp;Verify claim information</i></span></p> <p><span class="cmp-text__bodytextdark">Start with a claim number.</span><span class="cmp-text__bodytext"> If you have additional claims for the same type of issue, add them one of two ways:</span></p> <ul> <li><span class="cmp-text__bodytextdark">Enter claim numbers:</span><span class="cmp-text__bodytext"> When you have up to 50 claims</span></li> <li><span class="cmp-text__bodytextdark">Upload a CSV file:</span><span class="cmp-text__bodytext"> Up to 500 claims can be accepted at once. If you have more, submit them as a separate dispute.</span></li> </ul> <p><span class="cmp-text__bodytext">When submitting a bulk dispute, you’ll be asked to separate your claims by plan type.</span></p> <p>&nbsp;</p> <p><span class="cmp-text__bodytextdark"><i>Step 2: Add dispute information</i></span></p> <p><span class="cmp-text__bodytextdark">Describe your dispute</span><span class="cmp-text__bodytext"> and the steps we can take to resolve it.&nbsp;</span></p> <ul> <li><span class="cmp-text__bodytextdark">Add supporting documents:</span><span class="cmp-text__bodytext">&nbsp;You can attach up to 20 PDF, DOC, and XLS files of up to 50MB all together for most claims. Upload up to five files at a time. BlueCard® claims (for services to a member with an out-of-state plan) can include up to 20 PDF files of up to 10MB.</span></li> <li><span class="cmp-text__bodytextdark">Select a document type for attachments:</span><span class="cmp-text__bodytext">&nbsp;You can select medical record, contract/pricing, itemized bill, or other<br> &nbsp;</span></li> </ul> <p><span class="cmp-text__bodytextdark"><i>Step 3: Confirm contact information<br> </i>Confirm that your contact information is correct:<br> </span><span class="cmp-text__bodytext">All dispute correspondence will be sent to the email address you provide.</span></p> <p>&nbsp;</p> <p><span class="cmp-text__bodytextdark"><i>Step 4: Review and submit<br> </i>Review </span><span class="cmp-text__bodytext">your claim dispute for errors.</span></p> <ul> <li><span class="cmp-text__bodytextdark">Consent </span><span class="cmp-text__bodytext">to receive dispute notifications by email</span></li> <li><span class="cmp-text__bodytextdark">Non-contracted Medicare providers:</span><span class="cmp-text__bodytext"> You will be asked to accept a waiver of liability</span></li> <li><span class="cmp-text__bodytextdark">Sign your name:</span><span class="cmp-text__bodytext">&nbsp; The name you enter must match the name on your Contact information</span></li> <li><span class="cmp-text__bodytextdark">Select or enter today’s date</span></li> <li><span class="cmp-text__bodytextdark">Submit </span>&nbsp;</li> </ul> <h4><span class="cmp-text__bodytextdark">After submitting</span></h4> <p><span class="cmp-text__bodytext">You will receive confirmation with a case number(s) for each successfully submitted dispute right away.</span></p> <ul> <li><span class="cmp-text__bodytext">The dispute documents will be generated within 15 minutes after submission</span></li> <li><span class="cmp-text__bodytext">A message will be sent to the email address you have provided when an acknowledgement, determination, or any other letter is ready to be viewed online</span></li> <li><span class="cmp-text__bodytext">The messages will link you to the dispute page where you will be able to view dispute letters, records, and status updates</span></li> <li><span class="cmp-text__bodytext">You can upload additional documents until the dispute goes into review</span></li> <li><span class="cmp-text__bodytext">You can always find disputes and view letters&nbsp;on the&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/#/claims/claim-issues-dispute/submitted-disputes">Submitted disputes</a>&nbsp;page</span></li> </ul> <p><span class="cmp-text__bodytext">On the&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/#/claims/claim-issues-dispute/submitted-disputes">Submitted disputes</a>&nbsp;page, you can search and filter disputes submitted online, by mail, or another way. For additional information about a specific dispute, go the dispute page.&nbsp;</span><br> </p> <p><span class="cmp-text__bodytext">&nbsp;</span><br> </p> <h4><span class="cmp-text__bodytextdark"><i>Adding documents to open disputes</i></span><span class="cmp-text__bodytext"><span class="cmp-text__bodytextdark"></span></span></h4> <p><span class="cmp-text__bodytext">On the&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/#/claims/claim-issues-dispute/submitted-disputes">Submitted disputes</a>&nbsp;page, find a dispute using search or the filters. On the Dispute page, you can add documents until the dispute goes into review. If you’d like to submit more documents after that, you’ll need to open a new dispute following our <a title="Dispute guidelines" href="/en/provider/claims/disputes/dispute-process">dispute guidelines</a>.<br> &nbsp;</span></p> <h4><span class="cmp-text__bodytextdark">Important differences for BlueCard®&nbsp;claim disputes</span></h4> <p><span class="cmp-text__bodytext">The rules for filing BlueCard®&nbsp;disputes (for services to a member with an out-of-state plan) are slightly different.</span></p> <ul> <li><span class="cmp-text__bodytext">For BlueCard® claims, you can submit up to 20 PDF files of up to 10MB. Note, we may need to share these files with the member's out-of-state plan.</span></li> <li><span class="cmp-text__bodytext">You can submit multiple claims at the same time, as long as they are for services provided to the same member</span></li> <li><span class="cmp-text__bodytext">Up to 20 BlueCard®&nbsp;disputes can be created at one time</span></li> </ul> <p><span class="cmp-text__bodytext">See&nbsp;<a href="/en/provider/claims/disputes/faq-disputes">Frequently asked questions</a>&nbsp;for additional information. If you need more help,&nbsp;see <a title="Step-by-step instructions" href="/content/dam/bsca/en/provider/docs/2024/February/PRV_Online-PDR-tutorial.pdf" target="_blank">step-by-step instructions</a> on how to submit.</span></p> <p><span class="cmp-text__bodytext">For more information about the dispute resolution process, visit the <a title="Dispute review process and guidelines" href="/en/provider/claims/disputes/dispute-process">Dispute review process and guidelines</a> page.</span></p> <p><span class="cmp-text__bodytext">You can always <a title="Contact us" href="/en/provider/about-pc/contact-us">contact us</a> (via phone or chat) if you need help.</span></p> </div> </div> <div class="secondarylink aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--6 aem-GridColumn--offset--default--3"> <a class="button " href="#top" gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '#top', 'eventLabel': 'return to top', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" target="_self">return to top</a></div> <div class="spacer aem-GridColumn aem-GridColumn--default--12"> <div class="cmp-spacer cmp-spacer__desktop cmp-spacer__horizontal cmp-spacer__16"></div> <div class="cmp-spacer cmp-spacer__mobile cmp-spacer__horizontal cmp-spacer__8"></div> </div> <div class="text narrow-text aem-GridColumn aem-GridColumn--default--12"> <div id="text-4cac16a74a" class="rte-content cmp-text "> <h2><a id="authorizations"></a><br> Authorizations</h2> <h3>Medical authorizations</h3> <p><span class="cmp-text__bodytext">To find out whether medical authorization is required for a procedure or service, go to&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/authorization/pharmacyAuthorization" title="Request medical authorization">Authorizations&nbsp;&gt;&nbsp;Request&nbsp;medical&nbsp;authorization</a>.</span></p> <p><span class="cmp-text__bodytext">For help and step-by-step instructions on requesting authorizations and viewing authorization status, please visit the&nbsp;<a href="/en/provider/news-education/training/authaccel" title="AuthAccel online authorization training page">AuthAccel online authorization training page</a>.<br> &nbsp;</span></p> <h3>Pharmacy authorizations</h3> <p><span class="cmp-text__bodytext">To find out whether pharmacy authorization is required, go to&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/authorization/pharmacyAuthorization" title="Request pharmacy authorization">Authorizations&nbsp;&gt;&nbsp;Request&nbsp;pharmacy&nbsp;authorization</a>.</span></p> <p><span class="cmp-text__bodytext">For help and step-by-step instructions on requesting authorizations and viewing authorization status, please visit the&nbsp;<a href="/en/provider/news-education/training/authaccel" title="AuthAccel online authorization training page">AuthAccel online authorization training page</a>.</span></p> </div> </div> <div class="secondarylink aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--6 aem-GridColumn--offset--default--3"> <a class="button " href="#top" gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '#top', 'eventLabel': 'return to top', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" target="_self">return to top</a></div> <div class="spacer aem-GridColumn aem-GridColumn--default--12"> <div class="cmp-spacer cmp-spacer__desktop cmp-spacer__horizontal cmp-spacer__16"></div> <div class="cmp-spacer cmp-spacer__mobile cmp-spacer__horizontal cmp-spacer__8"></div> </div> <div class="text narrow-text aem-GridColumn aem-GridColumn--default--12"> <div id="text-fe02726447" class="rte-content cmp-text "> <h2><a id="manage-your-pc"></a><br> Managing your Provider Connection account</h2> <h3>Creating a Provider Connection user account<br> </h3> <p><span class="cmp-text__bodytext">Only Provider Connection account managers can create accounts for their users. Ask your account manager to create a Provider Connection account for you.</span></p> <p><span class="cmp-text__bodytext">Not sure whether you should be a user or an account manager? Here’s what each can do.</span></p> </div> </div> <div class="text aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--8 aem-GridColumn--offset--default--2"> <div id="text-5d395c93bd" class="rte-content cmp-text "> <table style="width: 100.0%;"> <tbody><tr><th style="width: 50.0%;"><span class="cmp-text__bodytext"> </span></th> <th style="width: 25.0%;"><span class="cmp-text__bodytext">User</span></th> <th style="width: 25.0%;"><span class="cmp-text__bodytext">Account Manager</span></th> </tr></tbody><tbody><tr><td style="text-align: left;"><span class="cmp-text__bodytext">View claims information</span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""/></span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""/></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Submit and view authorizations</span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""/></span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""/></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">View member eligibility information</span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""/></span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""/></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Create user accounts</span></td> <td><span class="cmp-text__bodytext"> </span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""/></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Manage access to TINs</span></td> <td><span class="cmp-text__bodytext"> </span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""/></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Grant access to claims and other information</span></td> <td><span class="cmp-text__bodytext"> </span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""/></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Reset Provider Connection user account passwords</span></td> <td><span class="cmp-text__bodytext"> </span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""/></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Disable, reactivate, or delete user accounts</span></td> <td><span class="cmp-text__bodytext"> </span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""/></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Approve billing manager access to TINs</span></td> <td><span class="cmp-text__bodytext"> </span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""/></span></td> </tr></tbody></table> </div> </div> <div class="text narrow-text aem-GridColumn aem-GridColumn--default--12"> <div id="text-731708b310" class="rte-content cmp-text "> <h2><span class="cmp-text__bodytext">Account managers must register for their own accounts. Then they can create user accounts at <a href="https://www.blueshieldca.com/providerwebapp/accountManagement/homePage">Account management &gt; Manage user accounts</a>.<br> </span><br> </h2> <h3>Logging in</h3> <p><span class="cmp-text__bodytext">You must log in to access the secure tools and content on Provider Connection. To log in, you have to have an account created by your organization’s Provider Connection account manager. You will need your username and password to log in.</span></p> <p><span class="cmp-text__bodytext">To log in:</span></p> <ul> <li><span class="cmp-text__bodytext">Enter your username in the username field.</span></li> <li><span class="cmp-text__bodytext">Enter your password in the password field.</span></li> <li><span class="cmp-text__bodytext">Select Log in.</span><br> &nbsp;</li> </ul> <h3>Managing your profile</h3> <p><span class="cmp-text__bodytext">To update your account profile or change your password, go to&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/manageMyProfile/profile" title="Manage my profile">Manage&nbsp;my&nbsp;profile</a>.</span></p> <p><span class="cmp-text__bodytext">You can update your name, address, phone number, username, email address, and email preferences here.</span></p> <p><span class="cmp-text__bodytext">Before you can make some changes, we email you a security code. This allows us to validate your identity and protect our members’ privacy.</span></p> <p><span class="cmp-text__bodytext">Note:&nbsp;Have opinions and ideas about how we can improve Provider Connection? Be sure to join our website user group and check the box next to Occasional surveys, both on&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/manageMyProfile/profile" title="Manage my profile">Manage&nbsp;my&nbsp;profile</a>.<br> &nbsp;</span></p> <h3>Changing your password</h3> <p><span class="cmp-text__bodytext">You must change your Provider Connection password:</span></p> <ul> <li><span class="cmp-text__bodytext">The first time you log in</span></li> <li><span class="cmp-text__bodytext">Every 90 days</span></li> <li><span class="cmp-text__bodytext">Anytime your password has been reset by an account manager or customer service</span></li> </ul> <p><span class="cmp-text__bodytext">If your password has expired, we’ll direct you to change it.<br> &nbsp;</span></p> <p><span class="cmp-text__bodytextdark">To change your password:</span></p> <ol> <li><span class="cmp-text__bodytext">On&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/manageMyProfile/profile">Manage&nbsp;my&nbsp;profile</a>, select Edit on the Password tile.</span></li> <li><span class="cmp-text__bodytext">Select Request code, and we’ll email you a security code.</span></li> <li><span class="cmp-text__bodytext">Enter the security code and select Continue.</span></li> <li><span class="cmp-text__bodytext">Enter your current password, a new password (twice), and select Save.</span></li> </ol> <p><span class="cmp-text__bodytext">If your account has been deactivated, contact your account manager. You can also&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/connect/connect/technicalSupportForm">fill&nbsp;out&nbsp;a&nbsp;Technical&nbsp;support&nbsp;form</a>&nbsp;or&nbsp;<a href="/en/provider/about-pc/contact-us">contact&nbsp;us</a>.</span><br> &nbsp;</p> <h3>If you forgot your username or password</h3> <p><span class="cmp-text__bodytext">If you can’t remember your username, get help at&nbsp;<a href="https://ping-ext.blueshieldca.com/ext/provider/prod?resumePath=/">Forgot your username?</a>&nbsp;Enter your full name and email address, and we’ll email your username to the email on file for your account.</span></p> <p><span class="cmp-text__bodytextdark">Pro tip:</span>&nbsp;<span class="cmp-text__bodytext">If you’re not sure which email address was used to create your account or your email has changed, check your email address at&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/manageMyProfile/profile">Manage&nbsp;my&nbsp;profile</a>. You can update it there first, then have your username emailed to the new address.</span></p> <p><span class="cmp-text__bodytext">If you forgot your password, get help at&nbsp;<a href="https://ping-ext.blueshieldca.com/ext/pwdreset/Identify?AdapterId=ProviderAdapter">Forgot your password?</a>&nbsp;Enter your username, and we’ll email a security code to the email on file for your account. Then you can change your password.</span></p> <p><span class="cmp-text__bodytext">Pro tip:&nbsp;If your account doesn’t have an email on file, we don’t recognize your username, or you haven’t yet verified your email after your account was created, we won’t be able to email you a security code. In those cases, you need to&nbsp;<a href="/en/provider/about-pc/contact-us">contact us</a>&nbsp;for help.<br> &nbsp;</span></p> <h3>Using your Message center</h3> <p><span class="cmp-text__bodytext"><a href="https://www.blueshieldca.com/providerwebapp/message-center" title="The Message center">The&nbsp;Message&nbsp;center</a>&nbsp;is where you receive messages about eligibility, benefits, and claims search results you’ve requested for other Blue plan and Federal Employee Program (FEP) members. Each user account has its own Message center—only you can see your messages.</span></p> <p><span class="cmp-text__bodytext">You can access your Message Center from any page in Provider Connection by clicking the link in the top navigation.</span></p> <p><span class="cmp-text__bodytext">Unread messages appear in bold. Once you've opened a message it will no longer appear in bold. You may mark a viewed message as unread by selecting its check box and then clicking the &quot;Mark as Unread&quot; icon at the top of the message list.</span></p> <p><span class="cmp-text__bodytext">Read messages are deleted after 45 days. To manually delete any message, check its checkbox in the list of messages, then click Delete. Once you delete a message, it is permanently removed from the system and cannot be retrieved.</span></p> <p><span class="cmp-text__bodytext">Other Blue plan and FEP members' eligibility and claims search results that cannot be retrieved within 45 seconds are automatically sent to your Message center when the search results are ready.</span></p> </div> </div> <div class="secondarylink aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--6 aem-GridColumn--offset--default--3"> <a class="button " href="#top" gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '#top', 'eventLabel': 'return to top', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" target="_self">return to top</a></div> <div class="spacer aem-GridColumn aem-GridColumn--default--12"> <div class="cmp-spacer cmp-spacer__desktop cmp-spacer__horizontal cmp-spacer__16"></div> <div class="cmp-spacer cmp-spacer__mobile cmp-spacer__horizontal cmp-spacer__8"></div> </div> <div class="text narrow-text aem-GridColumn aem-GridColumn--default--12"> <div id="text-6b03b92dfc" class="rte-content cmp-text "> <h2><a id="for-acct-mgrs"></a><br> For account managers</h2> <h3>Create a new user account</h3> <h3><span class="cmp-text__bodytext">Create user accounts for people in your organization who need access to the information associated with tax ID numbers (TINs). All users can view eligibility and authorization information. As the account manager, you can also grant them access to claims and real-time claims.</span></h3> <p><span class="cmp-text__bodytext">To create a user account, go to&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/accountManagement/homePage" title="Manage user accounts">Account management &gt; Manage user accounts</a>. Enter the person’s name and email address and assign them at least one TIN. You may choose to grant them access to claims information. If you do, you can also grant access to real-time claims information.</span></p> <p><span class="cmp-text__bodytext">What happens next: We’ll email them a temporary password right away. They have 30 days to visit the site and change their password or the account will be deleted. We’ll notify you 7 days before the account is deleted and again if it is deleted.</span></p> <p><span class="cmp-text__bodytext">Not sure whether you should be a user or an account manager? Here’s what each can do.</span></p> </div> </div> <div class="text aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--8 aem-GridColumn--offset--default--2"> <div id="text-c32bb6d8f2" class="rte-content cmp-text "> <table style="width: 100.0%;"> <tbody><tr><th style="width: 50.0%;"><span class="cmp-text__bodytext">&nbsp;</span></th> <th style="width: 25.0%;"><span class="cmp-text__bodytext">User</span></th> <th style="width: 25.0%;"><span class="cmp-text__bodytext">Account Manager</span></th> </tr></tbody><tbody><tr><td style="text-align: left;"><span class="cmp-text__bodytext">View claims information</span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""></span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Submit and view authorizations</span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""></span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">View member eligibility information</span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""></span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Create user accounts</span></td> <td><span class="cmp-text__bodytext">&nbsp;</span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Manage access to TINs</span></td> <td><span class="cmp-text__bodytext">&nbsp;</span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Grant access to claims and other information</span></td> <td><span class="cmp-text__bodytext">&nbsp;</span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Reset Provider Connection user account passwords</span></td> <td><span class="cmp-text__bodytext">&nbsp;</span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Disable, reactivate, or delete user accounts</span></td> <td><span class="cmp-text__bodytext">&nbsp;</span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""></span></td> </tr><tr><td style="text-align: left;"><span class="cmp-text__bodytext">Approve billing manager access to TINs</span></td> <td><span class="cmp-text__bodytext">&nbsp;</span></td> <td><span class="cmp-text__bodytext"><img src="/content/dam/bsca/en/shared/icons/32px/32px_Check_blue.svg" alt=""></span></td> </tr></tbody></table> </div> </div> <div class="text narrow-text aem-GridColumn aem-GridColumn--default--12"> <div id="text-ae64cd398a" class="rte-content cmp-text "> <p><span class="cmp-text__bodytext">Account managers must register for their own accounts. Then they can create user accounts at Account management &gt; Manage user accounts.<br> &nbsp;</span></p> <h3>Reset a user’s password to unlock their account</h3> <p><span class="cmp-text__bodytext">If a user becomes locked out of their account, reset their password to unlock it.<br> </span></p> <p><span class="cmp-text__bodytext">To do this, go to&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/accountManagement/homePage" title="Manage user accounts">Account&nbsp;management&nbsp;&gt;&nbsp;Manage&nbsp;user&nbsp;accounts</a>. You can reset passwords in two places: on the table of active and disabled accounts or on the individual user’s profile page (select their name in the table to get there).</span></p> <p><span class="cmp-text__bodytext">We’ll email the user a temporary password, which they’ll need to change upon login.</span><br> &nbsp;</p> <h3>Update a user’s access to tax ID numbers (TINs)</h3> <p><span class="cmp-text__bodytext">Manage your users’ access to tax IDs and the data connected to them. Access to a TIN includes all associated Blue Shield providers.</span></p> <p><span class="cmp-text__bodytext">To change a user’s TIN access, go to&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/accountManagement/homePage" title="Manage user accounts">Account&nbsp;management&nbsp;&gt;&nbsp;Manage&nbsp;user&nbsp;accounts</a>, then find and select their name in the table to go to their profile page. Check or uncheck the boxes to update their TINs, toggle claims access to yes or no, and select Save.</span><br> &nbsp;</p> <h3>Manage a user’s access to claims and real-time claims</h3> <p><span class="cmp-text__bodytextdark">Claims:</span><span class="cmp-text__bodytext">&nbsp;You can grant or restrict a user’s access to claims information for any tax ID (TIN). Claims access allows the user to search claim activity and check claim status associated with a tax ID number. Claims access also gives the user access to the professional fee schedule and the claims-routing tool.</span></p> <p><span class="cmp-text__bodytext">To change a user’s TIN access, go to&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/accountManagement/homePage" title="Manage user accounts">Account&nbsp;management&nbsp;&gt;&nbsp;Manage&nbsp;user&nbsp;accounts</a>, then find and select their name in the table to go to their profile page. Select a TIN or TINs on the list, then toggle claims access to yes or no and select Save.</span></p> <p><span class="cmp-text__bodytextdark">Real-time claims:</span>&nbsp;<span class="cmp-text__bodytext">Also on the user’s profile page, you can grant access to real-time claims. This allows the user to file claims through the Real-time claims tool.</span></p> <p><span class="cmp-text__bodytext">To change claims access, slide the claims and real-time claims toggles to yes or no and select Save.</span></p> <p><span class="cmp-text__bodytextdark">Note:</span><span class="cmp-text__bodytext">&nbsp;A user must have access to claims before you can give them access to real-time claims.</span><br> &nbsp;</p> <h3>User access to eligibility and authorization information</h3> <p><span class="cmp-text__bodytext">All users have access to this information for all their TINs by default. An account manager cannot restrict this access.</span><br> &nbsp;</p> <h3>Activate or disable a user’s account</h3> <p><span class="cmp-text__textlink">To change a user’s account status, go to&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/accountManagement/homePage" title="Manage user accounts">Account&nbsp;management&nbsp;&gt;&nbsp;Manage&nbsp;user&nbsp;accounts</a>, then find and select their name in the table. On their profile page, toggle their account status to active or disabled, then select Save.</span></p> <p><span class="cmp-text__bodytextdark">Pending:</span><span class="cmp-text__textlink">&nbsp;A new user account is pending until the user activates it. The user has 30 days to activate the account. After that, the system deletes it.</span></p> <p><span class="cmp-text__textlink">If you have pending accounts, these appear on the Pending accounts table at the top of Manage user accounts. You can see the date each account will expire if the user doesn’t activate it. You can also send the user a new temporary password from here if they lose the original one.</span></p> <p><span class="cmp-text__bodytextdark">Active:</span><span class="cmp-text__textlink">&nbsp;This means a user can log in to their Provider Connection account and access all associated TINs.</span></p> <p><span class="cmp-text__bodytextdark">Disabled:</span><span class="cmp-text__textlink">&nbsp;A disabled account is inaccessible to the user but can be reactivated by the account manager. Disable an account for a user who’s going on leave, for example.</span><br> &nbsp;</p> <h3>Delete an account</h3> <p><span class="cmp-text__bodytext">To delete an account, go to&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/accountManagement/homePage" title="Manage user accounts">Account&nbsp;management&nbsp;&gt;&nbsp;Manage&nbsp;user&nbsp;accounts</a>. Check the box next to the name of the user (or users) whose account you want to delete, then select Delete selected accounts, above the table. You’ll be asked to confirm before the account is deleted.</span></p> <p><span class="cmp-text__bodytextdark">Pro tip:</span><span class="cmp-text__bodytext">&nbsp;Once you delete an account, it’s gone and cannot be retrieved. For a temporary solution, consider disabling the account instead.<br> </span>&nbsp;</p> <h3>Transfer user accounts to another account manager</h3> <p><span class="cmp-text__bodytext">If you’ll be away from work, you need another account manager to assist your users while you’re gone. Transfer them to an account manager in your organization that shares access to the same TINs as the users.</span></p> <p><span class="cmp-text__bodytext">To transfer accounts, go to&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/accountManagement/homePage" title="Manage user accounts">Account&nbsp;management&nbsp;&gt;&nbsp;Manage&nbsp;user&nbsp;accounts</a>. On the table of accounts, check the boxes next to the names you want to transfer and select Transfer selected accounts (above the table). If one or more account managers share the same tax IDs as the users, you can transfer your users.</span></p> <p><span class="cmp-text__bodytext">If no other account manager in your organization has access to the same TINs, have any account manager add the TINs to their own account at&nbsp;<a href="https://www.blueshieldca.com/provider/account-tools/account-management/update-account-information.sp" title="Manage your Provider Connection tax IDs">Account&nbsp;management&nbsp;&gt;&nbsp;Manage&nbsp;your&nbsp;Provider&nbsp;Connection&nbsp;tax&nbsp;IDs</a>. Then you can transfer your users to them.</span></p> <p><span class="cmp-text__bodytext">If there’s no other account manager in your organization, someone should create a Provider Connection account to register. It’s important to have a backup.</span><br> &nbsp;</p> <h3>Edit a user’s profile information</h3> <p><span class="cmp-text__bodytext">Only a user can edit their name, username, and contact information. They do this on their&nbsp;<a href="https://www.blueshieldca.com/provider/account-tools/manage-profile/home.sp" title="Manage my profile">Manage&nbsp;my&nbsp;profile&nbsp;page</a>.<br> &nbsp;</span></p> <h3>Add or remove a tax ID number (for provider account managers)</h3> <p><span class="cmp-text__bodytext">To manage the tax IDs connected with your Provider Connection account, go to&nbsp;<a href="https://www.blueshieldca.com/provider/account-tools/account-management/update-account-information.sp" title="Manage your Provider Connection tax IDs">Account&nbsp;management&nbsp;&gt;&nbsp;Manage&nbsp;your&nbsp;Provider&nbsp;Connection&nbsp;tax&nbsp;IDs</a>.</span></p> <p><span class="cmp-text__bodytextdark">To add a TIN</span><span class="cmp-text__bodytext">, select Add tax IDs. To add some TINs, you need to provide information from one claim that’s:</span></p> <ul> <li><span class="cmp-text__bodytext">Either Blue Shield of California or Promise Health Plan</span></li> <li><span class="cmp-text__bodytext">From within the last three months</span></li> </ul> <p><span class="cmp-text__bodytext">For those claims, you need:</span></p> <ul> <li><span class="cmp-text__bodytext">A check/EFT number, claim number, or member ID number</span></li> <li><span class="cmp-text__bodytext">The check/EFT amount</span></li> </ul> <p><span class="cmp-text__bodytext">When you’ve successfully added the TIN, you’ll immediately have access to information associated with it.</span></p> <p><span class="cmp-text__bodytextdark">To remove a TIN</span><span class="cmp-text__bodytext">&nbsp;from your Provider Connection account, find the TIN listed in the table and select Remove.</span></p> <p><span class="cmp-text__bodytextdark">Note:</span><span class="cmp-text__bodytext">&nbsp;Adding and removing TINs on this page only affects your Provider Connection account. It doesn’t delete the records.</span><br> &nbsp;</p> <h3>Request access to a tax ID number (for billing service managers)</h3> <p><span class="cmp-text__bodytext">To manage the tax IDs connected with your Provider Connection account, go to&nbsp;<a href="https://www.blueshieldca.com/provider/account-tools/account-management/update-account-information.sp" title="Manage your Provider Connection tax IDs">Account&nbsp;management&nbsp;&gt;&nbsp;Manage&nbsp;your&nbsp;Provider&nbsp;Connection&nbsp;tax&nbsp;IDs</a>.</span></p> <p><span class="cmp-text__bodytextdark">To request access to a provider TIN</span><span class="cmp-text__bodytext">, select Add tax IDs. You need:</span></p> <ul> <li><span class="cmp-text__bodytext">The tax ID number of the organization you work for</span></li> <li><span class="cmp-text__bodytext">Provider TINs you want to add</span></li> <li><span class="cmp-text__bodytext">The Business Associate Agreement (BAA) date for each provider</span></li> </ul> <p><span class="cmp-text__bodytext">Once you request access, we immediately contact the provider. We'll email you when they approve your access. Then you’ll be able to access that TIN on Provider Connection. (If they deny your access, we’ll let you know that, too.)</span><br> &nbsp;</p> <h3>Add or remove a tax ID number (for MSO account managers)</h3> <p><span class="cmp-text__bodytext">To manage the tax IDs connected with your Provider Connection account, go to&nbsp;<a href="https://www.blueshieldca.com/provider/account-tools/account-management/account-manager-by-tax-id/home.sp" title="Manage your Provider Connection tax IDs">Account&nbsp;management&nbsp;&gt;&nbsp;Manage&nbsp;your&nbsp;Provider&nbsp;Connection&nbsp;tax&nbsp;IDs</a>.</span></p> <p><span class="cmp-text__bodytextdark">To add a TIN</span><span class="cmp-text__bodytext">, select Add tax IDs. You need:</span></p> <ul> <li><span class="cmp-text__bodytext">The tax ID number of the organization you work for</span></li> <li><span class="cmp-text__bodytext">TINs of the providers you’d like to represent (usually a nine-digit Employer Identification Number (EIN), though individual providers can use their Social Security number)</span></li> <li><span class="cmp-text__bodytext">The Business Associate Agreement (BAA) date for each provider</span></li> </ul> <p><span class="cmp-text__bodytext">For some provider TINs, you’ll also need a claim from within the last three months.</span></p> <p><span class="cmp-text__bodytext">When you’ve successfully added the TIN, you’ll immediately have access to information associated with it.</span></p> <p><span class="cmp-text__bodytextdark">To remove a TIN</span><span class="cmp-text__bodytext">&nbsp;from your Provider Connection account, find the TIN listed in the table and select Remove.<br> </span>&nbsp;</p> <h3>Update a provider’s demographic information</h3> <p><span class="cmp-text__bodytext">Provider and billing service account managers can update their provider’s information including contact info, specialties, and open hours at&nbsp;<a href="https://www.blueshieldca.com/providerwebapp/accountManagement/providerPractitionerProfiles" title="Provider demographic information">Account&nbsp;management&nbsp;&gt;&nbsp;Provider&nbsp;demographic&nbsp;information</a>. (MSO account managers can only view this information.) Select the pencil icon next to the section you want to update.</span></p> <p><span class="cmp-text__bodytext">We update the following information right away and display changes within 30 minutes of your request:</span></p> <ul> <li><span class="cmp-text__bodytext">Phone number</span></li> <li><span class="cmp-text__bodytext">Fax number</span></li> <li><span class="cmp-text__bodytext">Email</span></li> <li><span class="cmp-text__bodytext">Office hours</span></li> <li><span class="cmp-text__bodytext">Accepting new patients</span></li> <li><span class="cmp-text__bodytext">Wheelchair access</span></li> <li><span class="cmp-text__bodytext">Telehealth services</span></li> <li><span class="cmp-text__bodytext">Clinical staff languages</span></li> <li><span class="cmp-text__bodytext">Medical interpreter languages</span></li> <li><span class="cmp-text__bodytext">Areas of special expertise</span></li> </ul> <p><span class="cmp-text__bodytext">We must manually verify some information, and this takes time. Check back to see whether your changes have been processed. Information we must verify:</span></p> <ul> <li><span class="cmp-text__bodytext">NPI</span></li> <li><span class="cmp-text__bodytext">Primary specialty</span></li> <li><span class="cmp-text__bodytext">Other specialties</span></li> <li><span class="cmp-text__bodytext">Address</span></li> </ul> <p><span class="cmp-text__bodytext">To change any of the following demographic information,&nbsp;<a href="/content/dam/bsca/en/provider/unauth/documents/PRV_Provider_Demographic_Update_form.pdf">fill out this form</a>&nbsp;(PDF, 1.MB) and email it to&nbsp;<a href="mailto:BSCProviderInfo@blueshieldca.com">BSCProviderInfo@blueshieldca.com</a>.</span></p> <ul> <li><span class="cmp-text__bodytext">Name</span></li> <li><span class="cmp-text__bodytext">Provider type (practitioner, IPA/medical group, facility, other)</span></li> <li><span class="cmp-text__bodytext">PIN</span></li> <li><span class="cmp-text__bodytext">PIN assignment date</span></li> </ul> <p><span class="cmp-text__bodytextdark">Note:</span>&nbsp;<span class="cmp-text__bodytext">This information is essential to our members, and keeping it up-to-date is quick and easy. Please help us serve them by keeping it current!</span><br> &nbsp;</p> <h3>Are you an account manager?</h3> <p><span class="cmp-text__bodytext">Every provider needs an account manager. Account managers are authorized to enter into legally binding contracts on behalf of their employers. Typically, an account manager works:</span></p> <ul> <li><span class="cmp-text__bodytext">In a provider organization as an office manager or front-office staff</span></li> <li><span class="cmp-text__bodytext">For a billing service or MSO hired by the provider</span></li> </ul> <p><span class="cmp-text__bodytext">An account manager:</span></p> <ul> <li><span class="cmp-text__bodytext">Manages tax ID numbers (TINs) and Blue Shield provider identification numbers (PINs) associated with their organization</span></li> <li><span class="cmp-text__bodytext">Creates user accounts for others in the organization, creates usernames, and resets passwords</span></li> <li><span class="cmp-text__bodytext">Keeps the organization’s account information up-to-date</span></li> </ul> <p><span class="cmp-text__bodytext">To register as an account manager, you’ll be asked to sign a legal declaration.</span><br> &nbsp;</p> <h3>Register as a Provider Connection account manager (provider)</h3> <p><span class="cmp-text__bodytext">Providers&nbsp;deliver healthcare services to our plan members. They include doctors, hospitals, and medical groups.</span></p> <p><span class="cmp-text__bodytext">To register as a provider account manager, go to&nbsp;<a href="https://www.blueshieldca.com/provider/account-tools/login/home.sp" title="Log in/Create account">Log&nbsp;in/Create&nbsp;account</a>. Creating your account should take about 5 minutes.</span></p> <p><span class="cmp-text__bodytextdark">Pro tip:</span><span class="cmp-text__bodytext">&nbsp;When you register, look for the Need help? link available on each page. The step-by-step help that follows is available there, too.</span></p> <h4><span class="cmp-text__bodytextdark">What you need</span></h4> <p><span class="cmp-text__bodytext">Before you begin creating your Provider Connection account, be sure to gather:</span></p> <ul> <li><span class="cmp-text__bodytext">The tax ID number (TIN) of every provider in your organization (usually a nine-digit Employer Identification Number (EIN), though individual providers can use their Social Security number)</span></li> <li><span class="cmp-text__bodytext">For some, you need a claim from within the last three months</span></li> </ul> <h4><span class="cmp-text__bodytext"><br> </span><span class="cmp-text__bodytextdark">Steps for creating an account</span></h4> <p><span class="cmp-text__bodytext">Registering as a Provider Connection account manager has four steps:</span></p> <ol> <li><span class="cmp-text__bodytext">Choose your account type</span></li> <li><span class="cmp-text__bodytext">Enter the tax ID numbers (TINs) of your organization</span></li> <li><span class="cmp-text__bodytext">Enter contact info for your organization and yourself</span></li> <li><span class="cmp-text__bodytext">Select your username and password</span></li> </ol> <h4><span class="cmp-text__bodytextdark">Step 1 – Account type</span></h4> <p><span class="cmp-text__bodytext">The type of account you’ll choose depends on what kind of organization you work for:</span></p> <ul> <li><span class="cmp-text__bodytext">Provider</span></li> <li><span class="cmp-text__bodytext">Billing service</span></li> <li><span class="cmp-text__bodytext">Management services organization (MSO)</span></li> </ul> <h4><span class="cmp-text__bodytextdark">Step 2 – Tax ID numbers</span></h4> <p><span class="cmp-text__bodytext"><span class="cmp-text__tooltipstandin">For security reasons, we must verify that you’re authorized to represent the TINs you register with. We use claim information to do that.</span></span></p> <p><span class="cmp-text__bodytext">For each TIN, you may need to provide information from one claim that’s:</span></p> <ul> <li><span class="cmp-text__bodytext">Either Blue Shield of California or Promise Health Plan</span></li> <li><span class="cmp-text__bodytext">From within the last three months</span></li> </ul> <p><span class="cmp-text__bodytext">For those claims, you need:</span></p> <ul> <li><span class="cmp-text__bodytext">A check/EFT number, claim number, or member ID number</span></li> <li><span class="cmp-text__bodytext">The check/EFT amount</span></li> </ul> <p><span class="cmp-text__bodytextdark">Want to register quickly?</span><span class="cmp-text__bodytext">&nbsp;All you need to create your account is a single TIN with claim information. To finish creating your account faster, enter the information for just one TIN. You can always add more to your account after you log in.</span></p> <h4><span class="cmp-text__bodytextdark">Step 3 – Contact info</span></h4> <p><span class="cmp-text__bodytext">Here you enter your organization’s address. You also enter your contact information, including your phone and email address.</span></p> <h4><span class="cmp-text__bodytextdark">Step 4 – Account setup</span></h4> <p><span class="cmp-text__bodytext">You choose a username and password here. Then you must agree to our terms and conditions and sign a legal declaration.<br> &nbsp;</span></p> <h4><span class="cmp-text__bodytextdark">What happens next</span></h4> <p><span class="cmp-text__bodytext">Before you can log in, we need to verify your email address. To do that, we’ll email you a link. The link expires, so follow it promptly. (If the link expires, you can request another one.) Then you’re ready to log in!<br> &nbsp;</span></p> <h3>Register as a Provider Connection account manager (billing service)</h3> <p><span class="cmp-text__bodytext">Billing services&nbsp;are hired by providers to handle billing and claims. They do not deliver healthcare services to our members. (If you work in a provider organization and handle billing, register as a provider account manager.)</span></p> <p><span class="cmp-text__bodytext">To register as a billing service manager, go to&nbsp;<a href="https://www.blueshieldca.com/provider/account-tools/login/home.sp" title="Log in/Create account">Log&nbsp;in/Create&nbsp;account</a>. Creating your account should take about 5 minutes.</span></p> <p><span class="cmp-text__bodytextdark">Pro tip:</span>&nbsp;<span class="cmp-text__bodytext">When you register, look for the Need help? link available on each page. The step-by-step help that follows is available there, too.</span></p> <h4><span class="cmp-text__bodytextdark">What you need</span></h4> <p><span class="cmp-text__bodytext">Before you begin creating your Provider Connection account, be sure to gather:</span></p> <ul> <li><span class="cmp-text__bodytext">The tax ID number (TIN) of the organization you work for</span></li> <li><span class="cmp-text__bodytext">TINs of the providers you’d like to represent</span></li> <li><span class="cmp-text__bodytext">The Business Associate Agreement (BAA) date for each provider</span></li> </ul> <h4><span class="cmp-text__bodytextdark">Steps for creating an account</span></h4> <p><span class="cmp-text__bodytext">Registering as a Provider Connection account manager has 4 steps:</span></p> <ol> <li><span class="cmp-text__bodytext">Choose your account type</span></li> <li><span class="cmp-text__bodytext">Enter tax ID numbers (TINs) for your organization and the providers you want to represent</span></li> <li><span class="cmp-text__bodytext">Enter contact info for your organization and yourself</span></li> <li><span class="cmp-text__bodytext">Select your username and password</span></li> </ol> <h4><span class="cmp-text__bodytextdark">Step 1 – Account type</span></h4> <p><span class="cmp-text__bodytext">The type of account you’ll choose depends on what kind of organization you work for:</span></p> <ul> <li><span class="cmp-text__bodytext">Provider</span></li> <li><span class="cmp-text__bodytext">Billing service</span></li> <li><span class="cmp-text__bodytext">Management services organization (MSO)</span></li> </ul> <h4><span class="cmp-text__bodytextdark">Step 2 – Tax ID numbers</span></h4> <p><span class="cmp-text__bodytext">This step lets us connect your account to the information of your provider organizations.</span></p> <p><span class="cmp-text__bodytext">You need:</span></p> <ul> <li><span class="cmp-text__bodytext">The tax ID number (TIN) of the organization you work for</span></li> <li><span class="cmp-text__bodytext">TINs of the providers you want to represent</span></li> <li><span class="cmp-text__bodytext">The Business Associate Agreement (BAA) date for each provider</span></li> </ul> <h4><span class="cmp-text__bodytextdark">Step 3 – Contact info</span></h4> <p><span class="cmp-text__bodytext">Here you enter your organization’s address. You also enter your contact information, including your phone and email address.</span></p> <h4><span class="cmp-text__bodytextdark">Step 4 – Account setup</span></h4> <p><span class="cmp-text__bodytext">You choose a username and password here. Then you must agree to our terms and conditions and sign a legal declaration.</span></p> <h4><span class="cmp-text__bodytextdark">What happens next</span></h4> <ol> <li><span class="cmp-text__bodytext">You need to verify your email address. We’ll email you a link right away.</span></li> <li><span class="cmp-text__bodytext">We immediately contact the providers whose TINs you want to access.</span></li> <li><span class="cmp-text__bodytext">When the first provider approves your access, we’ll email you. Then you’ll be able to access Provider Connection and information associated with that TIN.</span></li> <li><span class="cmp-text__bodytext">You’ll receive access to any additional TINs you requested as we get confirmation from those providers. (If they deny your access, we’ll let you know that, too.)</span></li> </ol> <p>&nbsp;</p> <h3>Register as a Provider Connection account manager (MSO)</h3> <h3><span class="cmp-text__bodytextdark">Management services organizations (MSOs)</span><span class="cmp-text__bodytext">&nbsp;contract with providers to handle billing and other administrative services. Some MSOs own and manage the practices. They do not deliver healthcare services to our members.</span></h3> <p>&nbsp;</p> <p><span class="cmp-text__bodytext">To register as an MSO account manager, go to&nbsp;<a href="https://www.blueshieldca.com/provider/account-tools/login/home.sp" title="Log in/Create account">Log&nbsp;in/Create&nbsp;account</a>. Creating your account should take about 5 minutes.</span></p> <p><span class="cmp-text__bodytextdark">Pro tip:</span>&nbsp;<span class="cmp-text__bodytext">When you register, look for the Need help? link available on each page. The step-by-step help that follows is available there, too.<br> <br> </span></p> <h3>What you need</h3> <p><span class="cmp-text__bodytext">Before you begin creating your Provider Connection account, be sure to gather:</span></p> <ul> <li><span class="cmp-text__bodytext">The tax ID number (TIN) of the organization you work for</span></li> <li><span class="cmp-text__bodytext">TINs of the providers you’d like to represent (usually a nine-digit Employer Identification Number (EIN), though individual providers can use their Social Security number)</span></li> <li><span class="cmp-text__bodytext">The Business Associate Agreement (BAA) date for each provider</span></li> </ul> <h4><span class="cmp-text__bodytextdark">Steps for creating an account</span></h4> <p><span class="cmp-text__bodytext">Registering as a Provider Connection account manager has 4 steps:</span></p> <ol> <li><span class="cmp-text__bodytext">Choose your account type</span></li> <li><span class="cmp-text__bodytext">Enter tax ID numbers (TINs) for your organization and the providers you want to represent</span></li> <li><span class="cmp-text__bodytext">Enter contact info for your organization and yourself</span></li> <li><span class="cmp-text__bodytext">Select your username and password</span></li> </ol> <h4><span class="cmp-text__bodytextdark">Step 1 – Account type</span></h4> <p><span class="cmp-text__bodytext">The type of account you’ll choose depends on what kind of organization you work for:</span></p> <ul> <li><span class="cmp-text__bodytext">Provider</span></li> <li><span class="cmp-text__bodytext">Billing service</span></li> <li><span class="cmp-text__bodytext">Management services oreganization (MSO)</span></li> </ul> <h4><span class="cmp-text__bodytextdark">Step 2 – Tax ID numbers</span></h4> <p><span class="cmp-text__bodytext">For security reasons, we must verify that you’re authorized to represent the TINs you register with.</span></p> <p><span class="cmp-text__bodytext">For each TIN, you must enter:</span></p> <ul> <li><span class="cmp-text__bodytext">The Business Associate Agreement (BAA) date of the provider</span></li> </ul> <p><span class="cmp-text__bodytext">For some TINs, you may need to provide information for one claim that’s:</span></p> <ul> <li><span class="cmp-text__bodytext">Either Blue Shield of California or Promise Health Plan</span></li> <li><span class="cmp-text__bodytext">From within the last three months</span></li> </ul> <p><span class="cmp-text__bodytext">For those claims, you need:</span></p> <ul> <li><span class="cmp-text__bodytext">A check/EFT number, claim number, or member ID number</span></li> <li><span class="cmp-text__bodytext">The check/EFT amount</span></li> </ul> <p><span class="cmp-text__bodytext">Want to register quickly?&nbsp;All you need to create your account is a single TIN with a BAA date and claim information. To finish creating your account faster, enter the information for one TIN. You can always add more after you log in.<br> &nbsp;</span></p> <h4><span class="cmp-text__bodytextdark">Step 3 – Contact info</span></h4> <p><span class="cmp-text__bodytext">Here you enter your organization’s address. You also enter your contact information, including your phone and email address.<br> &nbsp;</span></p> <h4><span class="cmp-text__bodytextdark">Step 4 – Account setup</span></h4> <p><span class="cmp-text__bodytext">You choose a username and password here. Then you must agree to our terms and conditions and sign a legal declaration.</span></p> <h4><span class="cmp-text__bodytext">What happens next</span></h4> <p><span class="cmp-text__bodytext">Before you can log in, we need to verify your email address. To do that, we’ll email you a link. The link expires, so follow it promptly. (If the link expires, you can request another one.) Then you’re ready to log in!</span></p> </div> </div> <div class="secondarylink aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--6 aem-GridColumn--offset--default--3"> <a class="button " href="#top" gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '#top', 'eventLabel': 'return to top', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" target="_self">return to top</a></div> <div class="spacer aem-GridColumn aem-GridColumn--default--12"> <div class="cmp-spacer cmp-spacer__desktop cmp-spacer__horizontal cmp-spacer__16"></div> <div class="cmp-spacer cmp-spacer__mobile cmp-spacer__horizontal cmp-spacer__8"></div> </div> <div class="text narrow-text aem-GridColumn aem-GridColumn--default--12"> <div id="text-d0e6617e84" class="rte-content cmp-text "> <h2><span class="cmp-text__bodytext"><a id="tech-issues"></a><br> </span>Technical issues</h2> <h3>Compatible browsers and devices</h3> <p><span class="cmp-text__bodytext">Provider Connection is designed to work in specific browsers. For the best experience, use the latest version of the following browsers:</span></p> <p><span class="cmp-text__bodytextdark">Windows OS computers</span></p> <ul> <li><span class="cmp-text__bodytext">Google Chrome</span></li> <li><span class="cmp-text__bodytext">Microsoft Edge</span></li> </ul> <p><span class="cmp-text__bodytextdark">Apple macOS computers</span></p> <ul> <li><span class="cmp-text__bodytext">Google Chrome</span></li> </ul> <p><span class="cmp-text__bodytext">Some functionality on our website may not be compatible with Safari and Internet Explorer, as these browsers are not currently supported.<br> &nbsp;</span></p> <p><span class="cmp-text__bodytextdark">Using Provider Connection tools and resources on smart devices</span></p> <p><span class="cmp-text__bodytext">The Provider Connection tools and informational pages are responsive and can be viewed and used on smart devices such as tablets.</span></p> <p><span class="cmp-text__bodytext">For technical assistance,&nbsp;<a href="https://www.blueshieldca.com/provider/help/technical-support/home.sp">submit&nbsp;a&nbsp;technical&nbsp;support&nbsp;request</a>&nbsp;or&nbsp;<a href="/en/provider/about-pc/contact-us">contact&nbsp;us</a>.<br> &nbsp;</span></p> <h3>Contact us for assistance</h3> <p><span class="cmp-text__bodytext">If you need help using the site, your Provider Relations Coordinator or Contract Manager can provide a demonstration of site features as well as assist you with the registration process.</span></p> <p><span class="cmp-text__bodytext">If you need help obtaining your Blue Shield provider ID number (PIN), call<br> Blue Shield of California Provider Information and Enrollment at&nbsp;<a href="tel:18002583091" title="(800) 258-3091">(800) 258-3091</a><br> or Blue Shield Promise Provider Services at&nbsp;<a href="tel:18004689935" title="(800) 468-9935">(800) 468-9935</a>&nbsp;(TTY: 711), 8 a.m. to 5 p.m., Monday through Friday.</span></p> <p><span class="cmp-text__bodytext">For technical issues or problems,&nbsp;<a href="https://www.blueshieldca.com/provider/help/technical-support/home.sp">fill&nbsp;out&nbsp;a&nbsp;technical&nbsp;support&nbsp;form</a>&nbsp;or contact us at&nbsp;<a href="tel:18005416652" title="(800) 542-6652">(800) 541-6652</a>.</span></p> </div> </div> <div class="secondarylink aem-GridColumn--default--none aem-GridColumn aem-GridColumn--default--6 aem-GridColumn--offset--default--3"> <a class="button " href="#top" gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '#top', 'eventLabel': 'return to top', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" target="_self">return to top</a></div> <div class="spacer aem-GridColumn aem-GridColumn--default--12"> <div class="cmp-spacer cmp-spacer__desktop cmp-spacer__horizontal cmp-spacer__48"></div> <div class="cmp-spacer cmp-spacer__mobile cmp-spacer__horizontal cmp-spacer__24"></div> </div> <div class="custom__flex customflex_center aem-GridColumn aem-GridColumn--default--12"> <div class="cmp-primarycard cmp-primarycard__nobg" data-component="primary" data-title="Technical support request form"> <h2 class="cmp-primarycard__heading"> Technical support request form </h2> <div class="cmp-primarycard__description"><p><span class="cmp-text__bodytext">Request help with your log in, registration or other technical problems.</span></p> </div> <div class="btn-bottomalign"> <a data-title="Technical support request form" class="button arrowleft arrowxlleft" aria-label="Request tech support" href="https://www.blueshieldca.com/providerwebapp/connect/connect/technicalSupportForm" gtm-track-click="{'eventCategory': 'Click', 'eventAction': 'Card-Secondary Link', 'eventLabel': 'Request tech support', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" data-gtm-track-click="{'eventCategory': 'Click', 'eventAction': 'Image Card-Secondary Link', 'eventLabel': '', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" target="_self">Request tech support</a> </div> </div> <div class="cmp-primarycard cmp-primarycard__nobg" data-component="primary" data-title="Provider Connection Reference Guide"> <h2 class="cmp-primarycard__heading"> Provider Connection Reference Guide </h2> <div class="cmp-primarycard__description"><p><span class="cmp-text__bodytext">Find detailed instructions for activities like checking eligibility, making a referral, determining if prior authorization is necessary, prescreening claims, checking claims status, and other tools and information you need to serve our members.</span></p> </div> <div class="btn-bottomalign"> <a data-title="Provider Connection Reference Guide" class="button arrowleft arrowxlleft" aria-label="Provider Connection reference guide (PDF, 3 MB)" href="/content/dam/bsca/en/provider/docs/Provider-Connection-Reference-Guide.pdf" gtm-track-click="{'eventCategory': 'Click', 'eventAction': 'Card-Secondary Link', 'eventLabel': 'Provider Connection reference guide (PDF, 3 MB)', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" data-gtm-track-click="{'eventCategory': 'Click', 'eventAction': 'Image Card-Secondary Link', 'eventLabel': '', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" target="_blank">Provider Connection reference guide (PDF, 3 MB)</a> </div> </div> <div class="cmp-primarycard cmp-primarycard__nobg" data-component="primary" data-title="Contact us"> <h2 class="cmp-primarycard__heading"> Contact us </h2> <div class="cmp-primarycard__description"><p><span class="cmp-text__bodytext">Find phone and fax numbers for Blue Shield corporate offices, provider and pharmacy services, medical management, EDI program and technical services as well as contact information for Provider Connection specific features.</span></p> </div> <div class="btn-bottomalign"> <a data-title="Contact us" class="button arrowleft arrowxlleft" aria-label="Find contact information" href="/en/provider/about-pc/contact-us" gtm-track-click="{'eventCategory': 'Click', 'eventAction': 'Card-Secondary Link', 'eventLabel': 'Find contact information', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" data-gtm-track-click="{'eventCategory': 'Click', 'eventAction': 'Image Card-Secondary Link', 'eventLabel': '', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" target="_self">Find contact information</a> </div> </div> <div class="cmp-primarycard cmp-primarycard__nobg" data-component="primary" data-title="Manage your profile"> <h2 class="cmp-primarycard__heading"> Manage your profile </h2> <div class="cmp-primarycard__description"><p><span class="cmp-text__bodytext">Manage your profile, get help with your username and password, or access Message center.</span></p> </div> <div class="btn-bottomalign"> <a data-title="Manage your profile" class="button arrowleft arrowxlleft" aria-label="Manage profile" href="https://ping-ext.blueshieldca.com/as/authorization.oauth2?response_type=code&code_challenge=iBbV0E51Pz3H5Sn10toaZg2CxVsl7goonGljRoAaTGc&code_challenge_method=S256&client_id=pde-webapp&redirect_uri=https%3A%2F%2Fwww.blueshieldca.com%2Fpa%2Foidc%2Fcb&state=eyJ6aXAiOiJERUYiLCJhbGciOiJkaXIiLCJlbmMiOiJBMTI4Q0JDLUhTMjU2Iiwia2lkIjoiOC1MalN2VVotcjYteXFrdXhHTy10OTBkWEIwIiwic3VmZml4IjoiNE52NG9pLjE3MTA3NjU5NTYifQ..MwrRl844q2jyjYwFcK01Mw.F8hgGATsdtzWN9KSHh-jHr7lJaha16dn3F6W0lnbSSD6W7QWN5OGJ31MajYGyuqdDc_T2iTQPKIEgsjBeHy8vypN5gLt-O62_b0SJkFfZSKer1wdnq-TU558J4M66tMOxVU2UkI5uforLC1SrJrgh9Yry2Z-y05LTCsxrs8ElHyqQsvm7mY8GYWrN9WuonHk.mO9ppKbeiapwxxW9_LPsGQ&nonce=6XSOH5vf8OpmtdlkE9lv_DWRAck92F-e9OK_PuhVRTk&acr_values=formPDE%20formPDESpoof&scope=openid&vnd_pi_requested_resource=https%3A%2F%2Fwww.blueshieldca.com%2Fproviderwebapp%2F&vnd_pi_application_name=Provider+Connection+Authenticated" gtm-track-click="{'eventCategory': 'Click', 'eventAction': 'Card-Secondary Link', 'eventLabel': 'Manage profile', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" data-gtm-track-click="{'eventCategory': 'Click', 'eventAction': 'Image Card-Secondary Link', 'eventLabel': '', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" target="_self">Manage profile</a> <a data-title="Manage your profile" class="button arrowleft arrowxlleft" aria-label="Access message center" href="https://ping-ext.blueshieldca.com/as/authorization.oauth2?response_type=code&code_challenge=2ajN4eAH2nnkGrwnCNY-xMsMruT_z4oktba_AOe4OIs&code_challenge_method=S256&client_id=pde-webapp&redirect_uri=https%3A%2F%2Fwww.blueshieldca.com%2Fpa%2Foidc%2Fcb&state=eyJ6aXAiOiJERUYiLCJhbGciOiJkaXIiLCJlbmMiOiJBMTI4Q0JDLUhTMjU2Iiwia2lkIjoiOC1MalN2VVotcjYteXFrdXhHTy10OTBkWEIwIiwic3VmZml4IjoiUjJJTnF4LjE3MTA3NjU5ODAifQ..6Yu97uTj__QiNyNGmY9PAg.KuoLOy22lMbj65S4za_-OYKQGn6Mkizv2vmGXnFpgN3Z_6yvmDj-uG0VLZ46CL_Yani602rLQttrz_NHXUirliJTIp8cUx9l9LhBUNKr2LtDD6bh0gDNJI9lznXRhyoKinA7WxOq4mAGumViB3dZSGUS_751FR2Cy3zHUuXwLpFbA3Cr2x_R3D8L1scF7pf8.NAQJFIoAw-NNyHuHcuKgfw&nonce=XTl36VI47Z30vTLeqDmsSFsyuQJtmWUIfAYIL6U0Q4Y&acr_values=formPDE%20formPDESpoof&scope=openid&vnd_pi_requested_resource=https%3A%2F%2Fwww.blueshieldca.com%2Fproviderwebapp%2F&vnd_pi_application_name=Provider+Connection+Authenticated" gtm-track-click="{'eventCategory': 'Click', 'eventAction': 'Card-Secondary Link', 'eventLabel': 'Access message center', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" data-gtm-track-click="{'eventCategory': 'Click', 'eventAction': 'Image Card-Secondary Link', 'eventLabel': '', 'eventNonInteracton': 'false', 'event': 'eventTracker'}" target="_self">Access message center</a> </div> </div> </div> <div class="spacer aem-GridColumn aem-GridColumn--default--12"> <div class="cmp-spacer cmp-spacer__desktop cmp-spacer__horizontal cmp-spacer__48"></div> <div class="cmp-spacer cmp-spacer__mobile cmp-spacer__horizontal cmp-spacer__24"></div> </div> </div> </div> </div> <div class="footnotes aem-GridColumn aem-GridColumn--default--12"><div> </div></div> <div class="inheritance experiencefragment aem-GridColumn aem-GridColumn--default--12"> <div class="xfpage page basicpage"> <div id="container-5d08254eda" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="listoflinks background-primaryblck aem-GridColumn aem-GridColumn--default--12"> <div id="footer"> <footer class="cmp-footer" data-component="footer"> <div id="container-97c410ebe3" class="cmp-container"> <div class="cmp-footer__content"> <div data-component="footerlinks"> <div class="footer-link-list"> <div class="footer-link-item"> <h3>Provider tools</h3> <ul> <li class="listicons"><a class="listicons" href="/en/provider/guidelines-resources#prospect" target="_self" gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '/content/bsca/language-masters/en/provider/guidelines-resources#prospect', 'eventLabel': 'List: Become a Blue Shield Provider', 'eventNonInteracton': 'false', 'event': 'eventTracker'}">Become a Blue Shield Provider</a></li> <li class="listicons"><a class="listicons" href="/en/provider/news-education/webinars" target="_self" gtm-track-click="{'eventCategory': 'Provider', 'eventAction': '/content/bsca/language-masters/en/provider/news-education/webinars.html', 'eventLabel': 'List: Sign up for webinars', 'eventNonInteracton': 'false', 'event': 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