Dispute a claim decision online – FAQs

You can now submit disputes involving your commercial, Shared Advantage®, BlueCard®, Federal Employee Program (FEP), Medicare, and Medi-Cal through Provider Connection, in addition to using the existing mail-in process.

Submitting disputes online

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.


 

Disputes for the following Blue Shield of California claims can be filed online:

  • Commercial, including PPO, HMO, and IFP
  • Shared Advantage®
  • Federal Employee Program (FEP)
  • BlueCard® program 
  • Medicare, including Dual Eligible Special Needs Plan (D-SNP)

 

Medicare prescription drug plan (PDP), and dental plan disputes should be filed by mail.

You can also submit disputes for Blue Shield of California Promise claims online for:

  • Medi-Cal

Promise Medicare, Cal Medi-Connect (CMC) disputes should be filed 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.


 

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

You will be asked to indicate if the file is a medical record, contract/pricing, or an itemized bill. If you submit another kind of document, select Other and include a brief description.

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


 

Submitting bulk disputes online

Yes. Bundles must be for the same type of issue. You’ll be asked to separate your claims by plan type. There are two ways to submit:

  • 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

 

For all bulk disputes: 

  • Write one description
  • Attach the documents once
  • We will create bulk cases for all of the 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 CMS mandates that we collect waivers of liability, can’t be submitted in a bundle.


 

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. 


 

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 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. 

 

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.    


 

After you submit

You can lookup dispute status 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
  • You can also filter by dispute type (single or bulk) or whether it was submitted online or not
  • All disputes for the last 5 years are available for claims under your Tax IDs
  • For additional information about a specific dispute, go the dispute page

 

You will receive email notifications when letters are posted to your dispute page.

  • Find acknowledgment and determination letters, along with any other correspondence
  • Larger bulk disputes may also have a Claim list determination Excel file for you to download

All letters created after October 2022 will be available online for 5 years. Older letters have been archived. If you don’t see the letter you need, contact us and a Provider Services representative will get the letter for you.


 

You can add supporting documents to disputes that are still in the open status. On the Submitted disputes page, click on the dispute you need. Add documents from that dispute page.


 

The dispute review process is the same whether you submit online or by mail. You may receive the determination sooner if you submit online, because there is no wait for delivery and mail processing.


 

Troubleshooting

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.


 

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.  


 

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.
 

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. 


 

For more information

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

If you need more help, see step-by-step instructions on how to submit, or visit Provider Connection Help and see Claims > Dispute a claim decision online.

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

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