Dispute a claim decision online – FAQs

You need to be registered, signed in, and have access to claims on Provider Connection to submit disputes online. You can submit and view disputes for claims connected to the Tax IDs that you have access to. If you need additional access, talk to your Provider Connection account manager.

The dispute review process is the same whether you submit online or by mail. You may receive the determination sooner if you submit online.

You can submit disputes online for commercial, Shared Advantage®, Federal Employee Program (FEP), BlueCard®, Promise Medi-Cal, and Medicare claims.  File disputes for Promise Medicare, Cal Medi-Connect, Medicare prescription drug plan (PDP), and dental plan claims by mail.      

Search for a claim related to your dispute. Once you’ve selected a claim, you can start the dispute directly on the claim page. Click the "Resolve claim issue or dispute" link at the top of the page. Or, if you already know the claim number, you can enter it on the Claim issues and disputes page.  

Yes. For each new submission, whether initial or final, Blue Shield will assign a new case number.

Yes. Bundles must be for the same type of issue. There are two ways to submit depending on the number of claims you are bundling and the plan type:

• Entering claim numbers - when you have up to 50 claims.
• Uploading a CSV file. All claims in a bulk dispute must be for the same or similar issue.

For all bulk disputes: 

• Write one description.
• Attach the documents once.
• We will create bulk cases for all of your claims (except for BlueCard® claims where multiple disputes will be created).
• You will receive an acknowledgement and determination letter for each case we create.
• You will be able to view and download all documents from the Submitted disputes page.

You can only bundle Federal Employee Program (FEP) and BlueCard® claims if they’re for services provided to the same member. Also, Medicare claims for non-contracted providers where we have to collect waivers of liability can’t be submitted in a bundle.       

In Excel, you can export or save your file as a comma delimited CSV. Be sure to include: 

• Claim numbers in the first column
• A header row at the top

Label the first column “Claim Number” or “ICN” in the header. Additional columns can be included as needed (optional, will not be verified).

Claim numbers must match 
The claim numbers from the first column of your list will be checked against our records.

For your reference 
You can use this template as an example to create a spreadsheet of up to 500 claims for the same plan type.    

Upload your claim list (with up to 3,000 claims). We’ll return your list with notes on the plan types we find. You can then organize your list by plan type to submit for processing. 

If you are experiencing issues uploading or downloading a list of claims using a CSV file, check it carefully and:

• Remove extra characters, empty lines, empty column headers, or empty rows
• The top row must contain column headers and each line after that should start with a claim number 
• Limit your CSV file to 8 columns; only claim numbers will be checked
• Avoid adding over 3,000 claims to your list, even if you just want to check for plan types
• Avoid formatting fixes that Excel suggests when you reopen a CSV file, such as removing leading zeros from claim numbers or using scientific notation (for example, 2.3E+11)
  • It’s very important to submit a regular 12-digit claim number with nothing removed or changed so that it can be checked against our claim records
  • Consider checking your file in a text editor such as Notepad to avoid extra spaces or commas, or changing number formatting

If your CSV is not formatted correctly, we won’t be able to provide plan type notes for your claims.

You can submit up to 20 PDF, DOC, and XLS files of up to 50 MB for most claims. Upload up to five files at a time. 

You will be asked to provide additional information for each file, designating them as medical records, contract/pricing, itemized bills or other. Please include a description for each file you attach. 

For BlueCard® claims you can submit up to 20 PDF files of up to 10 MB. Note, we may need to share these files with the member’s out-of-state plan. Files that do not meet these requirements cannot be uploaded.  

Large files may take longer to upload on slow connections. If you are experiencing issues, wait a few minutes, then resubmit. You can also try uploading one file at a time instead of multiple files at once. If you’re still having trouble, contact us.  

You can add supporting documents to disputes that are still in the open or pending status. Go to the Submitted disputes page. Look for the Add documents link in the status column on the right. It will be there as long as the dispute is pending.

Look up dispute status and retrieve letters for a dispute you submitted in the past on the Submitted disputes page.

• Search and filter the list of disputes to find your dispute by case or claim number, member's last name, dates of service, or submission date. Disputes submitted online or by mail are on different tabs. 
• On a dispute record, you’ll find copies of the letters you’ve received via email, such as the determination letter and acknowledgement letter. 
• You can view and download determination letters or claim list response for bundled dispute submissions. 
• Disputes submitted by mail can be searched on a separate tab. 
• Disputes made within the last five years are available for claims under your Tax IDs.

If you’re receiving an error when loading the Submitted by mail disputes list, try refreshing the page.

If you have submitted disputes via PCH tool, you can see status under the Submitted by mail tab. You can also open filters and search for a specific case by case or claim number or other criteria. The Appeals status page is still available and can be used to look up dispute status as well until it migrates to the Submitted disputes page in the future. Note that records on the Appeal status page can take up to 24 hours to update. 

Starting October 2022, we’re extending the period of time you can view letters online from six months to two years. This applies to both online and mail submissions. During this time, if you don’t see the letter you need, contact us and a customer service representative will get the letter for you.

Submitting a dispute 

This message may appear when there is a connectivity issue or another problem. We suggest waiting a few minutes and resubmitting. If the problem continues, use the Feedback tab or contact us to let us know.

Searching for submitted dispute 

If you’re receiving an error when loading results, try refreshing the page. We are aware of the issue and working on getting it addressed. 

If you have submitted disputes via PCH tool, they may not be available at the moment. We are working on fixing this issue.

Uploading a file 

If you are receiving an error when uploading a file, check your connection, refresh the page, or start over by closing and re-opening your browser. 

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 10 MB. Note, we may need to share these files with the member’s out-of-state plan.  
• You can 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® claims can be created at one time. 

Please keep these in mind when you file. 

Yes, the manuals will be updated to include information about the new online dispute submission process.