Learning resources

This page contains recorded webinars, eLearning modules, FAQs, and step-by-step tutorials to help you serve Blue Shield and Blue Shield Promise Health Plan members, and work with Blue Shield effectively and efficiently.

Topics:
Blue Shield products, plans and networks
Claims and billing
Patient care
Health literacy
Provider data management
Pharmacy
Quality improvement

Blue Shield products, plans and networks

Trio HMO: Providing In-Person Care for Members Assigned to Virtual PCPs

Beginning in 2025, HMO Trio Network providers may receive referrals to provide in-person care for Trio HMO members who select Accolade Care as their medical group. Accolade Care delivers care virtually using telehealth video or phone calls. This guide covers the process to follow when providing in-person care to an Accolade Care member.
  Resource Guide (PDF, 1.5 MB)

  Frequently asked questions (PDF, 139 KB)

2025 Blue Shield Tandem PPO Network Resource Guide

Blue Shield’s Tandem PPO Network and Full PPO Network are different. This guide explains how to determine if you are contracted for participation in the Tandem PPO Network. If yes, the tools and tips contained within this guide will help you identify Tandem PPO plan members, whether your practice location can provide in-network services, and how to file claims to be accurately reimbursed.
  Resource Guide (PDF, 1.3 MB)
 

Intermediate Care Facilities/Developmentally Disabled transition

Effective January 1, 2024, Intermediate Care Facilities/Developmentally Disabled (ICF/DD) transitioned from fee-for-service to managed care plans for Medi-Cal beneficiaries. Blue Shield Promise is offering contracts to all ICF/DD-Habilitative and ICF/DD-Nursing facilities within our Los Angeles and San Diego county service areas that meet California Department of Public Health (CDPH) licensing and Medi-Cal enrollment requirements to join our quality network of providers. To learn more, click these links:
  FAQ for ICF/DD providers in Los Angeles and San Diego counties (PDF, 686 KB)
  Transportation FAQ for ICF/DD providers (PDF, 150 KB)
  Interactive resource guide for Blue Shield Promise ICF/DD providers eLearning course

Plan closures and transitions to Medicare Advantage HMO and D-SNP plans

The Blue Shield Coordinated Choice (HMO) plan and all Blue Shield Promise Cal MediConnect (CMC) plans ended December 31, 2022. All members automatically transition into an existing Blue Shield Medicare Advantage Prescription Drug Plan or Dual Eligible Special Needs Plan (D-SNP) as of January 1, 2023. This webinar explains these changes.
  Recorded webinar (50 min)
  Presentation (PDF, 3.3 MB)
  Frequently asked questions (PDF, 1 MB)
 

2023 Blue High Performance Network

Blue Shield of California’s Blue High Performance Network^SM (BlueHPN^SM) is a national exclusive provider organization (EPO) alternative to the BlueCard PPO Network offered to employer groups. BlueHPN providers offer care to Blue Shield of California members, as well as out-of-area members who purchase this coverage through other Blue Plans. To learn more, click this link to access a quick interactive module.
  eLearning course

Revised California Mental Health Parity Act (effective January 1, 2021)

This interactive tool is a quick way to learn about key updates to the law.
  eLearning course

Individual Medicare Advantage Prescription Drug Plans and Benefits Changes

Learn about 2021 changes to Medicare Advantage plans including Blue Shield Promise’s Medicare Contract, H5928, transfer to Blue Shield of California.
  2021 Individual Medicare Advantage prescription drug plans and benefits changes
  Recorded webinar (30 min)
  Presentation (PDF, 945 KB)

California Blue plans explained

Learn the differences between the two Blue plans in California from this one-page infographic:
  Who’s who in the world of Blue (PDF, 203 KB)

Medicare Advantage Coordination of Care Program

This interactive toolkit explains the requirements of Blue Shield network PPO participants providing care for BCBS Medicare Advantage members.
  eLearning course

Medicare PPO Tools and Tips Guide for Providers

If you are a participating in Blue Shield’s Medicare Advantage PPO provider network, this tool kit is designed to help to you when you are providing services for our Medicare Advantage PPO plan members.
  Blue Shield Medicare PPO tools and tips guide for providers (PDF, 2 MB)

Specialty Care Reimagined operations manuals for program providers

  Gastroenterology (PDF, 5 MB)
  OB/GYN – Maternity (PDF, 4 MB)
  Orthopedics (PDF, 7 MB)

Claims and billing

Updates for Blue Shield Promise Skilled Nursing Facility providers (December 2022)

This video covers benefits coordination, authorizations, claims, and billing in compliance with APL 22-018: Skilled Nursing Facilities - Long Term Care Benefit Standardization and Transition of Members to Managed Care. View and download the PDF for additional links to helpful resources.
  Video (20 min)
  Presentation (PDF, 1.4 MB)
 

Collecting Social Determinants of Health (SDOH) Data

Blue Shield of California Promise Health Plan uses specified SDOH Z codes to better target enhanced care management and community support programs to improve patient health, lessen disparities, deliver social benefits, and reduce healthcare utilization without impacting provider capitation payments. To learn more, click this link to access a quick interactive module for clinicians and staff.
  eLearning course

Improving Provider Encounter Data – 2023

Find out how you and your staff can improve the quality of encounter data submissions.
  January recorded webinar (29 min)
  January presentation (PDF, 2.8 MB)

  April recorded webinar (35 min)
  April presentation (PDF, 2.6 MB)

  July recorded webinar (31 min)
  July presentation (PDF, 2.9 MB)

  November recorded webinar (21 min)
  November presentation (PDF, 2 MB)

Submitting claims with taxonomy codes tutorial for Blue Shield and Blue Shield Promise providers

Taxonomy codes are required to identify provider specialties when filing claims. It is critical for multispecialty groups and dual-licensed providers to properly bill with taxonomy codes. This one-page job aid illustrates how do that, whether you are filing on the CMS 1500 form or electronically.
  Clean claims submission tips for professional providers (PDF, 24 KB)

Using Clear Claim Connection (C3) to prescreen claims

Learn how to use the Clear Claim Connection (C3) simulation tool to test HCPCS/CPT codes and view clinical edits with rationales.
  How to prescreen claims with C3 (PDF, 540 KB)

Patient care

Care for Transgender/Nonbinary patients

Barry Eisenberg, M.D. and Ilana Sherer, M.D., FAAP from the Palo Alto Medical Foundation/Sutter Health discuss how to help improve the healthcare experience of transgender and nonbinary youth, adolescents, and adults.
  Recorded webinar (55 min)
  Presentation (PDF, 4 MB)

To earn enduring Continuing Medical Education (CME) credit by viewing this webinar, visit Scripps Health.

Addressing Cardiac Care Disparities for Better Patient Outcomes

Dr. Columbus Batiste, chief of cardiology at Kaiser Permanente Riverside and Moreno Valley Medical Centers, addresses key health disparities in cardiac care and how to reduce their occurrence.
  Recorded webinar (51 min)
  Presentation (PDF, 7 MB)

Physician’s Practical Guide to Culturally Competent Care

A product of the Department of Health and Human Services Office of Minority Health (OHS), this training is a free online educational program that will equip you with the knowledge, skills and awareness to best serve the healthcare needs of patients regardless of their cultural or linguistic background.
   A Physician's Practical Guide to Culturally Competent Care

Transforming Medi-Cal through CalAIM

This is a one-stop shop for everything you need to know about California Advancing and Innovating Medi-Cal (CalAIM), including services, eligibility criteria, and referral processes for Blue Shield Promise programs that support CalAIM.
   eLearning course

Medi-Cal for Kids and Teens

This early and periodic screening, diagnostic, and treatment (EPSDT) training was designed and mandated by DHCS for every Medi-Cal clinician serving individuals under age 21 and must be completed every two years.
  eLearning course

Maternal Mental Health

This interactive guide is a quick way to learn about recommended screening tools and treatment resources that meet Senate Bill 1207 expanded requirements taking effect July 1, 2023.
  eLearning course

Initial Health Appointment (IHA) for Medi-Cal Members (4/2023)

This module clearly lays out IHA requirements for compliance, includes a downloadable list of recommended codes for accurate documentation and links to additional resources.
  eLearning course

Blue Shield Promise Physician Referrals to Behavioral Health (4/2023)

This quick interactive module gives Blue Shield Promise providers guidance for referring Medi-Cal members to mental health services and behavioral health treatment for members under 21.
  eLearning course

Tools and Resources for Behavioral Health Providers Serving Medi-Cal Members (3/2023)

Targeted to behavioral health providers in the Blue Shield of California Behavioral Health Specialist Network serving Blue Shield Promise Medi-Cal members, this webinar covered how to access behavioral health resources as well as how to register for Provider Connection and use key tools on the site.
  Recorded webinar
  Presentation (PDF, 3 MB)

Advance Care Planning: Tools for Starting the Conversation (10/2022)

Dr. Kimberly Bower shares insights, best practices, and tools for starting the advance care planning conversation with patients facing serious illness. Additionally, Dr. Bower provides an overview of Blue Shield’s Home-Based Palliative Care Program.
  Recorded webinar (54 min)
  Presentation (PDF, 2.9 MB)

Racism in American Medicine

Dr. Tina Sacks, Assistant Professor at UC Berkeley School of Social Welfare, and Dr. Lily Lamboy, Director of Diversity, Equity, and Inclusion at Blue Shield of California, discuss the latest research in health inequities and social determinants of health, and share insights from Blue Shield of California’s patient grievance data.
  Recorded webinar (54 min)
  Presentation (PDF, 683 KB)

Children’s Health Program

This webinar covers the services, eligibility criteria, and intake procedures for three statewide programs serving Medi-Cal eligible individuals with disabilities: California Children’s Services, Department of Developmental Services (DDS), and DDS’ Early Start programs.
  Recorded webinar (56 min)
  Presentation (PDF, 668 KB)
 

2024 Mandatory Care Coordination Annual Training

This course includes information about Long Term Services and Supports and other programs, social services case management, ADA accessibility and accommodations, Interdisciplinary Care Teams, Critical Incident Reporting and more.
  eLearning course
  Course PDF (PDF, 1.5 MB)
  Attestation Form

Implicit Bias in Healthcare and What You Can Do About It

Implicit bias refers to the brain’s instant association of attitudes or stereotypes toward groups without our conscious awareness. It can have the least obvious but most devastating impact on health equity. This interactive module is a quick way for clinicians and office staff to recognize and mitigate implicit bias.
  eLearning course

Improve Practice Efficiencies and Patient/Provider Joy by Asking, “What matters to you?” (August 2021)

“What Matters to You” (WMTY) is a simple question having a big impact on care quality, safety, and efficiency. This webinar provides practical and proven strategies for integrating WMTY into busy clinical practice settings.
  Recorded webinar (43 min)
  Presentation (PDF, 2.7 MB)

What your Lesbian, Gay, Bisexual, Transgender, and Questioning patients would like you to know (February 2020)

This webinar covers practical guidelines and considerations for providing inclusive health care to your LGBT/Q patients. Topics include creating a welcoming environment for LGBT/Q patients, using non-judgmental questions, and using language preferred by LGBT/Q patients.
  Recorded webinar (1.5 hours)
  Presentation (PDF, 1.3 MB)

Talking with Older Patients about Sensitive Topics

It can be difficult to talk with older patients about sensitive topics such as bladder control and sexual health. Brandon K. Koretz, MD, MBA, Professor of Clinical Medicine and Co-Chief, Division of Geriatrics at UCLA Health provides practical and proven strategies for addressing these topics.
  Recorded webinar (45 min)
  Presentation (PDF, 312 KB)

Fall prevention

Integrating fall prevention into clinical practice includes ensuring that everyone on staff is informed and involved. This 10-minute interactive module is designed to help medical office and hospital staff get up-to-speed on fall prevention best practices.
  eLearning course: Stop a fall, save a life: Integrating fall prevention into practice

There is such a wealth of fall prevention material online that it can be time consuming for providers to find what they need. Blue Shield has curated this set of online resources for quick and easy access to the best information, including resources to share with patients.
  Stop a fall, save a life: Fall prevention resource list (PDF, 53 KB)

Stop a Fall, Save a Life: Integrating Fall Prevention into Practice

Dr. Diana Homeier – Associate Professor at the Keck School of Medicine of USC and Medical Director at LAC+USC Geriatric Clinic and Adult Protection Team – presents practical, proven strategies for changing the way your practice approaches fall prevention.
  Recorded webinar (50 min)
  Presentation (PDF, 2.23 MB)

Providing Senior-Friendly Service

This 15-minute senior sensitivity elearning course gives participants the opportunity to gain knowledge, adopt attitudes, and modify behaviors that contribute to improving our senior patients’ experience.
  eLearning course

Patient/Physician Medical Appointment Summary Form

A non-branded form designed to help facilitate patient/physician communication during the medical appointment. It was created for Medicare patients, but should be helpful for all patients you see. Page 1 is completed by the patient and captures the visit reason and current health status. Page 2 is an after-visit summary completed by the doctor and provided to the patient as a takeaway.
  Online appointment summary form (PDF, 155 KB)
  Hard copy appointment summary form (PDF, 38 KB)

Referring Patients to Home-Based Palliative Care

This webinar describes how providers can refer qualified patients to Blue Shield’s Home-Based Palliative Care (HBPC) program. The session covers  HBPC patient eligibility requirements, the referral process, HBPC services provided as part of the program, and resources available to support referring providers. 
  Recorded webinar (48 min)
  Presentation (PDF, 1.8 MB)
  Webinar FAQ (PDF, 54 KB)

Home-Based Palliative Care Program Overview for Servicing Providers (2019)

This webinar describes Blue Shield’s home-based palliative care program from the perspective of a servicing provider. Topics included how to qualify and enroll patients, how to code and bill for hassle-free payment, and more.
  Recorded webinar (48 min)
  Presentation (PDF, 775 KB)

Use the tool below to qualify Blue Shield members for the Home-Based Palliative Care (HBPC) Program. Only members meeting the criteria outlined in this tool can be enrolled in the program.
  HBPC program patient eligibility screening tool (PDF, 105 KB)

This one-page job aid captures key steps that servicing providers should follow when assessing, enrolling, and caring for members in the HBPC program.
  HBPC program servicing provider checklist (PDF, 199 KB)

The support documents below are provided to help servicing providers meet program requirements.
  CMS 1500 claim form sample (PDF, 177 KB)
  CMS 1500 claim form sample – PMPM (PDF, 180 KB)
  HBPC program UB sample – Initial evaluation (PDF, 1.2 MB)
  HBPC program UB sample – PMPM (PDF, 1.2 MB)

Health literacy

Addressing low health literacy – Improve patient outcomes without adding time

Dr. Cliff Coleman, MD, MPH, a national expert in health literacy, presents communication best practices designed to improve patients’ understanding while not adding time to healthcare professionals’ busy workloads.
  Recorded webinar (59 min)
  Presentation (PDF, 885 KB)

Improving health literacy with plain language

In this 10-minute interactive module, you will learn why health literacy is important. And by the end, you’ll have the information and tools you need to use plain language as part of good health literacy practices.
  eLearning course

Provider data management

How to attest or update your provider directory information

Per federal and state law, contracted providers, facilities, and practitioners must attest to the accuracy of their provider directory information every 90 days and update that information if it changes. Blue Shield providers are required to attest and update via the Provider Connection website. 
  How to update or attest to provider information instructions (PDF, 264 KB)
  How to update or attest to provider information video (12 min)

As part of the validation process, you will need to update your provider directory information using the Provider Data Validation spreadsheet. The spreadsheet is available for download on Provider Connection in the Provider & Practitioner Profiles section under Bulk Updates. Additionally, a companion guide has been created to assist with completing the spreadsheet.

  Provider data validation companion guide (PDF, 352 KB)

Treatment Cost Estimator, Provider Data Review

Blue Shield's Treatment Cost Estimator is an online tool that assists PPO members in making informed healthcare choices by enabling them to compare cost estimates for selected network medical treatments and services. Members can also view options such as non-invasive treatment, and timelines to help them plan for healthcare needs in partnership with their providers.

With the backing of California legislation, including Senate Bill 1340, the transparency in health care supported by our Treatment Cost Estimator promotes shared decision-making between patients and their healthcare providers.

Our PPO network providers will receive the Provider Cost Estimate Report twice a year listing their cost estimate data that will be included in the Treatment Cost Estimator. Providers are encouraged to review this data. Here are some resources to help.
  How to read the provider cost estimate report (PDF, 106 KB)
  Provider cost estimate report FAQs for professional providers (PDF, 43 KB)
  BlueCross BlueShield cost estimate methodology for professional providers (PDF, 84 KB)
  Cost estimate report FAQs for facilities (PDF, 42 KB)
  BlueCross BlueShield cost estimate methodology for facilities (PDF, 98 KB)

Pharmacy

Medication Drop Ship Program

PPO providers and qualifying HMO providers can use the Medication Drop Ship Program with ASPN Pharmacies (ASPN) to order office-administered medications for specific members in Blue Shield commercial PPO plans, including Individual and Family Plans (IFPs). ASPN will triage and coordinate fulfillment of qualifying office-administered drugs and bill Blue Shield directly. View the video to learn more. The one-page job aid outlines how PPO providers submit a drop ship order via ASPN.

  Medication drop ship program (4 min)
  Medication drop ship program Quick Start Guide for PPO providers (PDF, 280 KB)

Biosimilars: A Safe and Effective Option for Patients

This interactive module is a quick way for physicians to review:

• The advantages of biosimilars
• FDA regulatory processes
• How to reduce the Nocebo Effect
• Blue Shield’s preferred drug list
• Drug-specific data

  eLearning course

Medication Selection Considerations for Medication-assisted Treatment (MAT)

MAT is one of the most effective interventions to combat opioid use disorders (OUD). Blue Shield pharmacists Tamara Tran and Stephen Jung discuss criteria and guidelines for MAT medication selection.
  Recorded webinar (40 min)
  Presentation (PDF, 744 KB)

Your Patient Suffered a Non-fatal Overdose...Now What? (NSI, 2019)

Dr. Andrea Rubinstein – anesthesiologist and Chief of Kaiser Permanente’s Santa Rosa Department of Pain Medicine – presents scenario-based strategies for how to reduce the risk of subsequent overdose in chronic pain patients who use opioids.
  Recorded webinar (1 hour, 5 min)
  Presentation (PDF, 2.33 MB)

Non-Pharmacological Approaches to Chronic Pain Management (NSI, 2018)

Dr. R. Corey Waller looks at the evidence behind complementary and alternative medicine approaches that may be helpful in chronic pain management.
  Recorded webinar (1 hour 5 min)
  Presentation (PDF, 862 KB)

Quality improvement

Depression Screening Documentation FAQ

To meet HEQMS and HEDIS® standards, providers must document depression screenings using LOINC® codes (Logical Observation Identifiers Names and Codes). This FAQ addresses questions related to this APL 22-028 mandate.

  Frequently asked questions (PDF, 487 KB)
 

Patient Experience in a Busy Clinic – How to Improve CAHPS Performance

Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys measure patient experience for all health plans and products. This interactive module is a quick and easy way for front office staff, clinicians, and physicians to learn what influences CAHPS scores and offers tips for how to improve.
  CAHPS e-learning course

Pharmacy tips for Medicare providers

This job aid answers some common questions about prescriptions and provides best practices that may help improve patient experience and CAHPS scores.
  Prescribing for a better patient experience (PDF, 146 KB)

What you need to know about the CAHPS Health Plan Survey

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey is a national, standardized survey used for measuring and reporting information on member experiences with health plans and their contracted providers. Read this overview to learn how patients’ perception and responses can impact value-based care and ultimately your practice.
  CAHPS Fact Sheet (PDF, 53 KB)
 

Provider Tips for Positively Impacting HOS Scores

This job aid focuses specifically on Hospital Outcome Survey (HOS) measures and provides recommendations for enhancing scores.
  Job aid (PDF, 79 KB)
 

Quick-tip videos to help improve HOS scores

  Talking to your Medicare patients about loneliness and social isolation (5 min)
  Talking to your Medicare patients about loneliness and social isolation flyer  (PDF, 120 KB)
  Talking to your older patients about mental health (4 min)
  Talking to your older patients about mental health (4 min)
  Talking to your older patients about Improving bladder control (4 min)
  Talking to your older patients about physical activity (5 min)
  Fall prevention tips (4 min)

Mission Possible! Simple Strategies for Improving Medication Adherence

• Dr. R. James Dudl shares simple, evidence-based ways to improve medication adherence.
    Recorded webinar (50 min)
    Presentation (PDF, 1.53 MB)