About Provider Connection

Provider Connection is your online source for current, detailed member eligibility and benefit information, claims status and payment information, authorization status and submission, Blue Shield policies and guidelines, and more.

Registered users can quickly access a variety of online resources, including:

Member eligibility and benefit information in the Eligibility and benefits section:

• Query up to 24 months of eligibility, updated daily
• View plan coverage information, including benefit limitations and authorization requirements
• Determine copayment, co-insurance, deductible and out-of-pocket accumulations
• Verify PCP assignment (current and historical)
• View claims mailing address
• Generate printer-friendly summary of eligibility and benefits
• Generate member roster for HMO PCPs
• Access HMO Benefit Guidelines and Summary of Benefits for other plans

 
Medical authorizations in the Authorizations section:

• Query status information for authorizations submitted via phone, fax, or online
• Submit authorization requests for most services (inpatient, outpatient, durable medical equipment or hospice/home health care services)
• Determine if authorization is required
• Search medical and medication policies
• Search drug database and formulary

 
Claim status and payment information in the Claims section:

• Query up to 24 months of your pending and finalized claims, updated daily
• View/print/download copies of your Explanation of Benefits
• View/print/download payment reports for reconciling both checks and electronic deposits
• View/print/download claims activity reports for accounts-receivable management
• Look up PPO professional fee schedule allowances, and payment policies
• Review special guidelines for claim forms for billing and electronic claims information
• Learn about how to enroll for electronic remittance advice (ERA) and electronic funds transfer (EFT)

 
Other resources in the Guidelines and resources section:

• View/print/download provider manuals, and newsletters
• Find guidelines, policies, and procedures
• Use Find a Provider to assist with referrals
• Provide resources for your patients

Note: Registered providers can access eligibility, authorizations and claims information for most Blue Shield members (does not include Medicare+Choice membership).

Claims or authorizations not processed by Blue Shield of California, which may include pharmacy, behavioral health, or dental benefits, are not available online.
 

Register for Provider Connection

Providers, billing services, and management service organizations may register online in minutes. In order to register, you must provide your provider organization tax identification number. Begin registration, or to determine if you organization already has an Account Manager by entering your organization's Tax ID.

For security reasons, if someone from your organization has already registered, please contact that Account Manager in order to obtain your own user account. Each user of the Provider portal is required to have their own unique username and password. Sharing of usernames and passwords violates the Provider Connection portal terms of use and will result in the account being disabled.

Organizations are also prohibited from using “automated” scrapping programs on our site to mine data. Scrapping programs impact portal performance and will result in the account being disabled.
 

Join our provider networks

To enjoy the full benefits of Provider Connection, including access to your claims information, you must either join our networks, or request a non-participating provider record. This also allows you to exchange electronic claims transactions with us. Learn how to join our provider networks