Using Blue Shield of California’s Claims-Routing Tool

When you send claims, it’s crucial that you understand where the claims should go. It's frustrating for providers when their claims get denied because they selected the incorrect insurance company name when registering a patient or updating their information.

Providers or staff can use Blue Shield of California’s online claims-routing tool to easily determine the correct insurance name, such as Anthem or Blue Cross Cali, and  the correct mailing address. 

The Claims-Routing Tool is a great tool for verifying if the claim is being routed to the correct claims processing center (whether EDI or paper).  Note that this tool is free to use and you don't require to login. 

Accessing the Claims-Routing Tool

1. Go the official website of Blue Shield California. Click the link here to get started. Click the Provider link on the top right corner of the website as shown here.

2. On the Provider page of Blue Shield California, scroll down to the Claims section. Click on the "Claims-Routing Tool" link as shown here.

3. On the Claims-Routing Tool page, follow the below instructions to get more details about the insurance plan, company name, and address: a. Enter the three-character alpha prefix* displayed on the Member ID card. b. Enter the date of service (The date can be up to 36 months before and 31 days after the current date). c. Click the "Search" button. The result will show where to submit your claim.

*Most Blue Cross and Blue Shield (BCBS) branded ID cards display a three-character alpha prefix in the first three positions of the member’s ID number. The alpha prefix helps you determine insurance eligibility and benefits, and is necessary for proper claim filing. 

*Federal Employee Program (FEP) members’ ID cards do not have a three-character alpha prefix. Rather, all FEP member identification numbers begin with the letter "R". 

Remember: Member ID cards are for identification purposes only; they do not guarantee eligibility or payment of your claim. You should always verify patient eligibility by calling 800-676-BLUE (2583).

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