Provider Connection help

Find help in creating a Provider Connection account, viewing authorization status, working with claims, receiving messages, and more.

Eligibility and benefits  |  Claims  |  Authorizations  |  Managing your Provider Connection account  |  For account managers  |  Technical issues

Eligibility and benefits

Verifying eligibility and benefits for a single member

Select the Search single member tab on the verify eligibility page 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.
 

To search for a Blue Shield of California or Promise Health Plan member:

1. Choose 'Blue Shield of California / Promise Health Plan' as the card type. 
2. There are three options for the next step: 
   • Search by the subscriber ID (9-16 alphanumeric characters) or 
   • Search by the member's last name, first name, and date of birth or 
   • Search by the member’s Social security number, Medicare beneficiary number, or Client index number. 
3. When you’ve completed steps 1 and 2, click Search. 

Note: 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. 
 

To search for other Blue plan or Federal Employee Program (FEP) members:

1. Choose the member coverage or card type.
2. Select the member type. The subscriber is the primary member. A dependent is any family member covered by the subscriber’s plan.
3. 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.
4. 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.
5. Choose the Service category and Service type to request specific benefit information.
6. Click Search.
   

Tips:

• All search fields are required.
• You can identify an FEP member by the ID prefix R00 to R99.
• 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.
• 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.

Snapshot of a single member’s eligibility

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.
 

A Blue Shield of California member’s eligibility snapshot includes:

• Member name
• Subscriber ID
• Eligibility status based on current medical coverage.
• Basic member information: Birth date, gender, and residence address
• Coverage information: Plan name, plan type, coverage start and end date, Relationship to subscriber, and subscriber name
• PCP name
• In-network office visit copay information
• Links to member details, ID card, benefits, and claims
   

A Promise Health Plan member’s eligibility snapshot includes:

• Member name
• Subscriber ID
• Eligibility status based on current medical coverage.
• Basic member information: Birth date, gender, and residence address
• Coverage information: plan name, coverage effective date, redetermination date, relationship to subscriber, and subscriber name. 
• PCP name and participating provider group information
• Medicare beneficiary ID and/or client index number, as applicable 
• Links to member details, ID card, benefits, and claims
  • 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.
     

Other Blue plan or Federal Employee Program member’s eligibility snapshot includes:

• Member name
• Member ID
• Eligibility status based on current medical coverage.
• Basic member information: Birth date, gender, and residence address
• Plan type, coverage period, and relationship to subscriber
• Links to member details, benefits, and deductibles/out-of-pocket maximums information
   

Verifying eligibility and benefits for multiple Blue Shield of California and Promise Health Plan members

You can search for eligibility and benefits information for up to 10 Blue Shield of California or Promise Health Plan members at a time. Select the Search multiple members tab on the erify eligibility page. (Multiple search is not available for other Blue plan and FEP members.)

To search for multiple members:

1. Enter the Member IDs (9–16 alphanumeric characters) for up to 10 members. Examples:
   • XEA123456789,
   • J12345678,
   • 123456789
2. Click Search.

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.

• 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.
• 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.

Note: 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.
 

Member eligibility details (Blue Shield of California and Promise Health Plan members)

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.
 

Member eligibility details contain:

• Member eligibility snapshot, including subscriber ID and eligibility status.
• 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).
• 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).
• 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.
• Deductibles and out-of-pocket maximums are displayed for Ccrrent, future, and past coverage. 
   

Deductible and out-of-pocket maximum details

The deductible and out-of-pocket maximum details show accumulative and current deductible and out-of-pocket information.

• 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.
• 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. 
• 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
   

Benefit details

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 Evidence of coverage. Find more information about benefits and services for a member’s plan in section 4 of the Medi-Cal Evidence of Coverage (EOC).

Note: You may view current or historical benefits-coverage data by selecting a time period from the coverage period drop-down.
 

Member rosters

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.

• Search the roster based on practice or provider name. You can also filter by provider name, provider address, PIN, or IPA/medical group. 
• Sort by status using the arrow next to the column header. 
• Click the Export icon to download a single roster type.
• See which members are new or whose status has changed in the last 30 days.
• View a breakdown of the member roster by attribution status (active, new, disenrolled, redetermined, and on-hold).  Click on the count under each status for a detailed member list that can be downloaded and saved to your computer.

Claims

Searching claims

Providers can search for claims submitted for Blue Shield of California, Promise Health Plan, other Blue plan (including BlueCard), and Federal Employee Program (FEP) members.

When you visit the Claim status search page, the 1,000 most recent claims load automatically. Then you can filter and search for specific claims.

Filtering, sorting, and exporting

• Narrow your list of claims by number, member, or provider information.
• Sort by column headings such as member name, provider name, date of service, or ID Number.
• BlueCard claims are indicated by the BlueCard icon.  
• See up to 5,000 records at a time by exporting the list.
  • Select Export, then a spreadsheet will download to your computer.
  • The exported spreadsheet detailed information on each claim.
    
     

Claims list

• Click on a column header to sort by that column.
• Click on a claim number to see its details, including service and claim notes.
• Payment decisions are explained in the claim notes and on the EOB.
• Click View EOB to see an EOB for a claim.
• Click the claim’s EFT number to see information about all claims paid by that transaction.
  
   

Downloading EOBs

To locate an EOB, go to the Check claim status page. Click View EOB for any of the claims listed. You can also download EOBs from the Claims detail page.
 

Viewing claim information

In the claim page header, you will see the status: finalized or in process. For finalized claims, you can download EOB or perform other actions: 

• Attach supporting documents* 
  • Upload up to 20 documents, PDF, DOC or XLS, up to 50 MBs (for most claims) and provide a description for your submission. 
  • See the confirmation number generated once you submit. 
  • View a list of documents you uploaded 
     
• Resolve claim issue or dispute a claim 
  • Initiate a dispute online for a Commercial, Shared Advantage or BlueCard claim.

*After a claim has been paid in full, the link to Attach supporting documents will disappear.
 

Summary and full view

• See all claims associated with the member for the claim you’re viewing under member information. 
• View the status history of adjusted claims, including dates they’ve been received and finalized, billed and paid amounts, and more. 
• Review additional claims that may be relevant based on member ID, the provider, dates of service, and the amount billed. 
• Get a summary view of the member information and claim details sections. Expand the sections by clicking Full view. 

Payment details

• Link to Check/EFT number details  
• See all claims paid by check or Electronic fund transfer (EFT). 
• View the payee's name and address where the paper checks were mailed.

Claim history

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. 
 

Uploaded documents 

View a list of documents for this claim what were uploaded online through Provider Connection.
 

For BlueCard claims

• 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. 
• Request status, eligibility, and benefits information from out-of-state plans directly from the claims page.  
• View available letters linked in BlueCard claim header

Finding EOBs by amount paid or amount billed

To locate an EOB by amount, go to the Check claim status page. Select the Amount paid drop down. Then choose to filter by the amount paid or the amount billed.
 

Finding claims by check or EFT number

To find a claim by check or EFT number, go to the Check claim status page. Search for a check or EFT number using those entry fields
 

Claims-routing tool

To find out where you should send a BlueCard claim, enter the three-character prefix and the date of service into the claims-routing tool.

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.

The date of service is the month, day, and year a Blue Cross or Blue Shield member received medical services from the provider.
 

Prescreen claims with Clear Claim Connection (C3)

Clear Claim Connection (C3) 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.

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.
 

Dispute a claim decision online

There are two ways to initiate an online dispute: Search for a claim, then from the Claim page, click the “Resolve claim issue or dispute” link in the header. Or you can go to the Claim issues and disputes page and enter a claim number there.
 

To complete your submission:

Step 1:  Verify claim information

Start with a claim number. If you have additional claims for the same type of issue, add them one of two ways:

• Enter claim numbers: When you have up to 50 claims
• Upload a CSV file: Up to 500 claims can be accepted at once. If you have more, submit them as a separate dispute.

When submitting a bulk dispute, you’ll be asked to separate your claims by plan type.

Step 2: Add dispute information

Describe your dispute and the steps we can take to resolve it. 

• Add supporting documents: 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.
• Select a document type for attachments: You can select medical record, contract/pricing, itemized bill, or other
   

Step 3: Confirm contact information
Confirm that your contact information is correct:
All dispute correspondence will be sent to the email address you provide.

Step 4: Review and submit
Review your claim dispute for errors.

• Consent to receive dispute notifications by email
• Non-contracted Medicare providers: You will be asked to accept a waiver of liability
• Sign your name:  The name you enter must match the name on your Contact information
• Select or enter today’s date
• Submit  

After submitting

You will receive confirmation with a case number(s) for each successfully submitted dispute right away.

• The dispute documents will be generated within 15 minutes after submission
• 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
• The messages will link you to the dispute page where you will be able to view dispute letters, records, and status updates
• You can upload additional documents until the dispute goes into review
• You can always find disputes and view letters on the Submitted disputes page

On the Submitted disputes 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. 

Adding documents to open disputes

On the Submitted disputes 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 dispute guidelines.
 

Important differences for BlueCard® claim disputes

The rules for filing BlueCard® disputes (for services to a member with an out-of-state plan) are slightly different.

• 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.
• You can submit multiple claims at the same time, as long as they are for services provided to the same member
• Up to 20 BlueCard® disputes can be created at one time

See Frequently asked questions for additional information. If you need more help, see step-by-step instructions on how to submit.

For more information about the dispute resolution process, visit the Dispute review process and guidelines page.

You can always contact us (via phone or chat) if you need help.

Authorizations

Medical authorizations

To find out whether medical authorization is required for a procedure or service, go to Authorizations > Request medical authorization.

For help and step-by-step instructions on requesting authorizations and viewing authorization status, please visit the AuthAccel online authorization training page.
 

Pharmacy authorizations

To find out whether pharmacy authorization is required, go to Authorizations > Request pharmacy authorization.

For help and step-by-step instructions on requesting authorizations and viewing authorization status, please visit the AuthAccel online authorization training page.

Managing your Provider Connection account

Creating a Provider Connection user account

Only Provider Connection account managers can create accounts for their users. Ask your account manager to create a Provider Connection account for you.

Not sure whether you should be a user or an account manager? Here’s what each can do.

Account managers must register for their own accounts. Then they can create user accounts at Account management > Manage user accounts.

Logging in

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.

To log in:

• Enter your username in the username field.
• Enter your password in the password field.
• Select Log in.
   

Managing your profile

To update your account profile or change your password, go to Manage my profile.

You can update your name, address, phone number, username, email address, and email preferences here.

Before you can make some changes, we email you a security code. This allows us to validate your identity and protect our members’ privacy.

Note: 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 Manage my profile.
 

Changing your password

You must change your Provider Connection password:

• The first time you log in
• Every 90 days
• Anytime your password has been reset by an account manager or customer service

If your password has expired, we’ll direct you to change it.
 

To change your password:

1. On Manage my profile, select Edit on the Password tile.
2. Select Request code, and we’ll email you a security code.
3. Enter the security code and select Continue.
4. Enter your current password, a new password (twice), and select Save.

If your account has been deactivated, contact your account manager. You can also fill out a Technical support form or contact us.
 

If you forgot your username or password

If you can’t remember your username, get help at Forgot your username? Enter your full name and email address, and we’ll email your username to the email on file for your account.

Pro tip: If you’re not sure which email address was used to create your account or your email has changed, check your email address at Manage my profile. You can update it there first, then have your username emailed to the new address.

If you forgot your password, get help at Forgot your password? Enter your username, and we’ll email a security code to the email on file for your account. Then you can change your password.

Pro tip: 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 contact us for help.
 

Using your Message center

The Message center 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.

You can access your Message Center from any page in Provider Connection by clicking the link in the top navigation.

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 "Mark as Unread" icon at the top of the message list.

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.

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.

For account managers

Create a new user account

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.

To create a user account, go to Account management > Manage user accounts. 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.

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.

Not sure whether you should be a user or an account manager? Here’s what each can do.

Account managers must register for their own accounts. Then they can create user accounts at Account management > Manage user accounts.
 

Reset a user’s password to unlock their account

If a user becomes locked out of their account, reset their password to unlock it.

To do this, go to Account management > Manage user accounts. 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).

We’ll email the user a temporary password, which they’ll need to change upon login.
 

Update a user’s access to tax ID numbers (TINs)

Manage your users’ access to tax IDs and the data connected to them. Access to a TIN includes all associated Blue Shield providers.

To change a user’s TIN access, go to Account management > Manage user accounts, 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.
 

Manage a user’s access to claims and real-time claims

Claims: 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.

To change a user’s TIN access, go to Account management > Manage user accounts, 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.

Real-time claims: 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.

To change claims access, slide the claims and real-time claims toggles to yes or no and select Save.

Note: A user must have access to claims before you can give them access to real-time claims.
 

User access to eligibility and authorization information

All users have access to this information for all their TINs by default. An account manager cannot restrict this access.
 

Activate or disable a user’s account

To change a user’s account status, go to Account management > Manage user accounts, then find and select their name in the table. On their profile page, toggle their account status to active or disabled, then select Save.

Pending: 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.

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.

Active: This means a user can log in to their Provider Connection account and access all associated TINs.

Disabled: 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.
 

Delete an account

To delete an account, go to Account management > Manage user accounts. 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.

Pro tip: Once you delete an account, it’s gone and cannot be retrieved. For a temporary solution, consider disabling the account instead.
 

Transfer user accounts to another account manager

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.

To transfer accounts, go to Account management > Manage user accounts. 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.

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 Account management > Manage your Provider Connection tax IDs. Then you can transfer your users to them.

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.
 

Edit a user’s profile information

Only a user can edit their name, username, and contact information. They do this on their Manage my profile page.
 

Add or remove a tax ID number (for provider account managers)

To manage the tax IDs connected with your Provider Connection account, go to Account management > Manage your Provider Connection tax IDs.

To add a TIN, select Add tax IDs. To add some TINs, you need to provide information from one claim that’s:

• Either Blue Shield of California or Promise Health Plan
• From within the last three months

For those claims, you need:

• A check/EFT number, claim number, or member ID number
• The check/EFT amount

When you’ve successfully added the TIN, you’ll immediately have access to information associated with it.

To remove a TIN from your Provider Connection account, find the TIN listed in the table and select Remove.

Note: Adding and removing TINs on this page only affects your Provider Connection account. It doesn’t delete the records.
 

Request access to a tax ID number (for billing service managers)

To manage the tax IDs connected with your Provider Connection account, go to Account management > Manage your Provider Connection tax IDs.

To request access to a provider TIN, select Add tax IDs. You need:

• The tax ID number of the organization you work for
• Provider TINs you want to add
• The Business Associate Agreement (BAA) date for each provider

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.)
 

Add or remove a tax ID number (for MSO account managers)

To manage the tax IDs connected with your Provider Connection account, go to Account management > Manage your Provider Connection tax IDs.

To add a TIN, select Add tax IDs. You need:

• The tax ID number of the organization you work for
• 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)
• The Business Associate Agreement (BAA) date for each provider

For some provider TINs, you’ll also need a claim from within the last three months.

When you’ve successfully added the TIN, you’ll immediately have access to information associated with it.

To remove a TIN from your Provider Connection account, find the TIN listed in the table and select Remove.
 

Update a provider’s demographic information

Provider and billing service account managers can update their provider’s information including contact info, specialties, and open hours at Account management > Provider demographic information. (MSO account managers can only view this information.) Select the pencil icon next to the section you want to update.

We update the following information right away and display changes within 30 minutes of your request:

• Phone number
• Fax number
• Email
• Office hours
• Accepting new patients
• Wheelchair access
• Telehealth services
• Clinical staff languages
• Medical interpreter languages
• Areas of special expertise

We must manually verify some information, and this takes time. Check back to see whether your changes have been processed. Information we must verify:

• NPI
• Primary specialty
• Other specialties
• Address

To change any of the following demographic information, fill out this form (PDF, 1.MB) and email it to BSCProviderInfo@blueshieldca.com.

• Name
• Provider type (practitioner, IPA/medical group, facility, other)
• PIN
• PIN assignment date

Note: 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!
 

Are you an account manager?

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:

• In a provider organization as an office manager or front-office staff
• For a billing service or MSO hired by the provider

An account manager:

• Manages tax ID numbers (TINs) and Blue Shield provider identification numbers (PINs) associated with their organization
• Creates user accounts for others in the organization, creates usernames, and resets passwords
• Keeps the organization’s account information up-to-date

To register as an account manager, you’ll be asked to sign a legal declaration.
 

Register as a Provider Connection account manager (provider)

Providers deliver healthcare services to our plan members. They include doctors, hospitals, and medical groups.

To register as a provider account manager, go to Log in/Create account. Creating your account should take about 5 minutes.

Pro tip: When you register, look for the Need help? link available on each page. The step-by-step help that follows is available there, too.

What you need

Before you begin creating your Provider Connection account, be sure to gather:

• 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)
• For some, you need a claim from within the last three months

Steps for creating an account

Registering as a Provider Connection account manager has four steps:

1. Choose your account type
2. Enter the tax ID numbers (TINs) of your organization
3. Enter contact info for your organization and yourself
4. Select your username and password

Step 1 – Account type

The type of account you’ll choose depends on what kind of organization you work for:

• Provider
• Billing service
• Management services organization (MSO)

Step 2 – Tax ID numbers

For security reasons, we must verify that you’re authorized to represent the TINs you register with. We use claim information to do that.

For each TIN, you may need to provide information from one claim that’s:

• Either Blue Shield of California or Promise Health Plan
• From within the last three months

For those claims, you need:

• A check/EFT number, claim number, or member ID number
• The check/EFT amount

Want to register quickly? 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.

Step 3 – Contact info

Here you enter your organization’s address. You also enter your contact information, including your phone and email address.

Step 4 – Account setup

You choose a username and password here. Then you must agree to our terms and conditions and sign a legal declaration.
 

What happens next

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!
 

Register as a Provider Connection account manager (billing service)

Billing services 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.)

To register as a billing service manager, go to Log in/Create account. Creating your account should take about 5 minutes.

Pro tip: When you register, look for the Need help? link available on each page. The step-by-step help that follows is available there, too.

What you need

Before you begin creating your Provider Connection account, be sure to gather:

• The tax ID number (TIN) of the organization you work for
• TINs of the providers you’d like to represent
• The Business Associate Agreement (BAA) date for each provider

Steps for creating an account

Registering as a Provider Connection account manager has 4 steps:

1. Choose your account type
2. Enter tax ID numbers (TINs) for your organization and the providers you want to represent
3. Enter contact info for your organization and yourself
4. Select your username and password

Step 1 – Account type

The type of account you’ll choose depends on what kind of organization you work for:

• Provider
• Billing service
• Management services organization (MSO)

Step 2 – Tax ID numbers

This step lets us connect your account to the information of your provider organizations.

You need:

• The tax ID number (TIN) of the organization you work for
• TINs of the providers you want to represent
• The Business Associate Agreement (BAA) date for each provider

Step 3 – Contact info

Here you enter your organization’s address. You also enter your contact information, including your phone and email address.

Step 4 – Account setup

You choose a username and password here. Then you must agree to our terms and conditions and sign a legal declaration.

What happens next

1. You need to verify your email address. We’ll email you a link right away.
2. We immediately contact the providers whose TINs you want to access.
3. 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.
4. 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.)

Register as a Provider Connection account manager (MSO)

Management services organizations (MSOs) 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.

To register as an MSO account manager, go to Log in/Create account. Creating your account should take about 5 minutes.

Pro tip: When you register, look for the Need help? link available on each page. The step-by-step help that follows is available there, too.

What you need

Before you begin creating your Provider Connection account, be sure to gather:

• The tax ID number (TIN) of the organization you work for
• 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)
• The Business Associate Agreement (BAA) date for each provider

Steps for creating an account

Registering as a Provider Connection account manager has 4 steps:

1. Choose your account type
2. Enter tax ID numbers (TINs) for your organization and the providers you want to represent
3. Enter contact info for your organization and yourself
4. Select your username and password

Step 1 – Account type

The type of account you’ll choose depends on what kind of organization you work for:

• Provider
• Billing service
• Management services oreganization (MSO)

Step 2 – Tax ID numbers

For security reasons, we must verify that you’re authorized to represent the TINs you register with.

For each TIN, you must enter:

• The Business Associate Agreement (BAA) date of the provider

For some TINs, you may need to provide information for one claim that’s:

• Either Blue Shield of California or Promise Health Plan
• From within the last three months

For those claims, you need:

• A check/EFT number, claim number, or member ID number
• The check/EFT amount

Want to register quickly? 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.
 

Step 3 – Contact info

Here you enter your organization’s address. You also enter your contact information, including your phone and email address.
 

Step 4 – Account setup

You choose a username and password here. Then you must agree to our terms and conditions and sign a legal declaration.

What happens next

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!

Technical issues

Compatible browsers and devices

Provider Connection is designed to work in specific browsers. For the best experience, use the latest version of the following browsers:

Windows OS computers

• Google Chrome
• Microsoft Edge

Apple macOS computers

• Google Chrome

Some functionality on our website may not be compatible with Safari and Internet Explorer, as these browsers are not currently supported.
 

Using Provider Connection tools and resources on smart devices

The Provider Connection tools and informational pages are responsive and can be viewed and used on smart devices such as tablets.

For technical assistance, submit a technical support request or contact us.
 

Contact us for assistance

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.

If you need help obtaining your Blue Shield provider ID number (PIN), call
Blue Shield of California Provider Information and Enrollment at (800) 258-3091
or Blue Shield Promise Provider Services at (800) 468-9935 (TTY: 711), 8 a.m. to 5 p.m., Monday through Friday.

For technical issues or problems, fill out a technical support form or contact us at (800) 541-6652.