Blue Shield of California Claim Address and Dispute Resolution Process

Blue Shield of California has a specific process for resolving disputes over claims. This process is outlined on their website.

To start the dispute resolution process, you'll need to contact Blue Shield of California's customer service department. You can reach them by phone, email, or mail.

If your claim is denied, you'll receive a letter explaining the reason for the denial. This letter will also include information on how to appeal the decision.

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Submitting claims electronically is an efficient way to get your claims processed quickly, and Blue Shield offers this option.

You can learn more about electronic claims submission by visiting the Blue Shield website, where you'll find resources to help you get started.

To submit clean claims, keep in mind that Blue Shield provides a PDF guide with tips on how to do it correctly, and it's only 24 KB in size.

Blue Shield encourages you to use their electronic claims submission process to avoid any potential delays or issues.

If this caught your attention, see: Electronic Medical Billing

To resolve disputes with Blue Shield of California, you'll want to submit your claims in writing to the correct address. Initial disputes should be sent to the Blue Shield Initial Dispute Resolution Office at P.O. Box 272620 in Chico, CA 95927-2620.

You can also submit disputes regarding facility contract exceptions to the same office, but make sure to address the envelope to the Hospital Exception and Transplant Team at P.O. Box 629010 in El Dorado Hills, CA 95762-9010.

For final disputes, send your claims to the Blue Shield Final Provider Dispute and Resolution Office at P.O. Box 629011 in El Dorado Hills, CA 95762-9011.

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Misdirected claims for HMO members can be a real headache. Claims for capitated services provided to a Blue Shield HMO member that are sent to Blue Shield for processing/payment in error will be forwarded to the appropriate capitated provider within 10 working days of receipt.

Claims for non-capitated services provided to a Blue Shield HMO member that are submitted to the capitated IPA or Medical Group for processing are required to be forwarded to Blue Shield by the capitated IPA or Medical Group within 10 working days.

Blue Shield will send an Explanation of Benefits (EOB) to the billing provider as notification that the claim was forwarded to the appropriate capitated provider. This helps ensure that the billing provider is aware of the claim's status and can take further action if needed.

Claims for non-capitated services that are forwarded to Blue Shield are required to be handled within the standard claims processing timeframe.

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If you're a provider looking to resolve disputes with Blue Shield, you'll want to know where to send your dispute resolution forms.

You can submit initial disputes in writing to the Blue Shield Initial Dispute Resolution Office at P.O. Box 272620 in Chico, CA 95927-2620.

For disputes regarding facility contract exceptions, submit your form to the Blue Shield Initial Dispute Resolution Office at P.O. Box 629010 in El Dorado Hills, CA 95762-9010, Attention: Hospital Exception and Transplant Team.

For final disputes, send your form to the Blue Shield Final Provider Dispute and Resolution Office at P.O. Box 629011 in El Dorado Hills, CA 95762-9011.

If you have a Medicare Advantage Plan, submit your disputes in writing to Blue Shield Provider Dispute Resolution at P.O. Box 272640 in Chico, CA 95927-2640, Attn: Medicare Advantage.

For Blue Shield of California Promise Health Plans, submit disputes regarding Promise plans in writing to Blue Shield of California Promise Health Plan at P.O. Box 8309 in Chico, CA 95927-8309.

Here are the addresses for each type of dispute:

You can file a Blue Shield of California claim by mail, phone, or online, and it's a good idea to keep a record of your claim and any supporting documentation.

To start the claims process, you'll need to submit a claim form, which can be downloaded from the Blue Shield of California website or obtained by calling their customer service number.

Blue Shield of California has a dedicated claims department that reviews and processes claims in a timely manner, usually within 7-10 business days.

You can track the status of your claim online or by contacting the claims department directly.

Keep in mind that the claims process may take longer if additional information is needed or if there are any issues with your claim.