Blue Shield of California

Welcome to the Blue Shield of California Health Plan page.  The documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent is responsible for. Additional process-specific training tools and modules can be found via links on the Resources tab at the top of the screen.

If you have any questions about our programs, please contact [email protected].

Blue Shield of California (Blue Shield): New Site of Care Requirements for Advanced Imaging – Effective April 22, 2026 for Commercial plans and May 18, 2026 for group Medicare PPO.

Blue Shield of California, in collaboration with Evolent, is updating its prior authorization process for non‑emergent advanced imaging services managed by Evolent. Beginning April 22, 2026, prior authorization requests for MRI/MRA, CT/CTA, and PET scans will include a site of care review to ensure services are performed in the most clinically appropriate setting (provider office or ambulatory surgery center).

• Applies to Group Medicare PPO effective May 18, 2026
• Applies to fully insured Commercial PPO members effective April 22, 2026
• Applies to Commercial HMO/POS members with directly contracted medical group (i.e. DCHMO) and Trio HMO members with a virtual PCP effective April 22, 2026
• Authorizations issued before the above noted effective dates remain valid through their expiration date
• Site of Care policy, advanced imaging utilization review matrices, and other resources including our RadMD Site of Care training video are available below.

For questions or additional support, please contact [email protected].

Peer-to-Peer Process  

For access to our peer-to-peer process, click here.

Conservative Treatment Forms  

For access to our conservative treatment forms, click here.