Why Blue Shield Isn’t Paying You Back

A Guide to Blue Shield of California Provider Enrollment

In 2016, Blue Shield of California instituted a new policy requiring all healthcare providers — even those who take no insurance — to complete a Provider Enrollment Application before Blue Shield will reimburse their clients’ out-of-network claims. Completing these forms does not enter providers into a contractual relationship with Blue Shield, but it enables their patients to get paid back for care. To make this process easier, here is a simple breakdown that explains how to complete the Provider Enrollment Form.

Why did Blue Shield of California Change their Process?

Before 2016, Blue Shield of California only required a provider superbill to reimburse an out-of-network claim. According to Blue Shield’s Provider Relations Department, the system was changed as part of a broader integration of digital information within the company and also to combat fraud. There was no formal announcement of this change. However, the company does send a letter to providers when a claim is denied due to the provider not being enrolled in their database.

The Blue Shield provider enrollment process requires:

• Completion of the out-of-network enrollment form
• Proof of provider EIN
• If you do not have a EIN for your business and use your SSN on your superbills, Blue Shield requires a signed W-9 to certify your SSN
• Any additional supporting documentation required on Page 2 of the enrollment form

Completing the out-of-network enrollment form:

The form itself is simple and takes only a few minutes to complete. Most of the information required is standard. The form is not a contract, nor does it credential you as an in-network provider. It is simply a request for information.

• Solo Practice: Tick New provider record in the left-hand corner.
• Group Practice: Tick New group or Business entity record.
• Complete the sections named “Provider of Service” and “Physical Location” below, adding your name and address.
• Also, please add your billing reimbursement information, even though you will not be receiving reimbursements from Blue Shield. The form needs to be completed in its entirety or it will be rejected by their system.
• In the right hand column, you should add your practice information, including type of service, license and NPI numbers, Tax ID and Social Security. Blue Shield does require your SSN.

Important note: If you bill as a group practice, in addition to completing the group form, each individual provider in the practice must also complete the form separately with their personal information. These individual forms should be submitted with a separate letter explaining which providers are part of your group. We are happy to create this letter for you; please email us at support@getbetter.co.

• You can speak to the Blue Shield provider enrollment department directly at 800–258–3091 should you prefer.

Proof of provider EIN:

Blue Shield also requires proof of EIN. This can be provided in two ways and Blue Shield will accept the following:

• SS-4 form — When you were given an EIN, the IRS should have provided you with an SS-4 documenting your number. If you do not have this, here are instructions for getting another copy: http://info.legalzoom.com/copy-ss4-corporation-23821.html
• Alternatively, request this information by calling the IRS at 800–829–0115 (7am-7pm) in your time zone. Ask the agent to send you a 147C letter. There is no charge and you can ask the agent to fax it to you. You will be asked security questions, such as the name and address of the business, the type of business income tax form you file, your name, and your position within the company.

We Are Here To Help

To make this even simpler for providers recommending Better to their patients, you are welcome to email the completed form and the proof of EIN directly to provider@getbetter.co. We will review and submit the form directly to Blue Shield so we can track its progress. Blue Shield can take up to 90 days to process these forms. We will check the status of pending applications and catch issues quickly so you don’t have to.

We know this is an unnecessary headache. We are always happy to answer any questions you may have about this process.