Blue Shield of California
Welcome to the Blue Shield of California Health Plan page. Here you can download policies and procedures specific to both ordering and rendering providers. These include quick reference guides and information designed to assist you in using RadMD to request and check the status of prior authorizations.
If you have any questions about our programs, please contact your dedicated NIA Provider Relations Manager, April Sabino.
To support the benefit change that is being implemented for many of your PPO patients Blue Shield of CA and NIA are educating providers about facility options available for the delivery of advanced imaging diagnostic services ordered. NIA will provide information to providers if the facility selected could result in a higher out of pocket cost to the patient. NIA will assist the provider in selecting an alternate facility that best meets their patient needs.
Blue Shield of California has implemented a Musculoskeletal program that includes spine surgery and interventional pain management for Blue Shield PPO plan members. The program will include dates of service on and after January 1, 2017.
- IPM Utilization Review Matrix-2022
- Spine Surgery Utilization Review Matrix-2022
- Frequently Asked Questions
- Provider Training PPT
- Utilization Review Matrix-2022 - updated 7/1/2022
- Peer-to-Peer Process
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
RadMD is a user-friendly, real-time tool offered by Magellan Healthcare that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by program:
Recorded General Trainings
We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.
Recorded RadMD Demos
Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.
- Clinical Guidelines
Refer to the Utilization Review Matrix document to view specific codes managed by NIA
Clinical Training Modules
We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.
Update on COVID-19
Click here to view our recommendations on the use of CT to detect Coronavirus (COVID-19).