Referral & Pre-certification Request Forms
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Referral Request Form Due to COVID-19, as of March 16, 2020 and until further notice, no referrals from University Health Services are needed before accessing medical and mental health care. If needed, please see this UHS letter for documentation. |
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Pre-certification Request Form for Medical & Behavorial Health Services Submit request with current and relevant clinical documentation to Wellfleet. |
Phone: (833) 302-9785 |
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Pre-certification Request Form for Transgender Services Fax request with supporting documentation to the SHIP Office. |
Fax: (510) 642-9119 |
Provider Contacts
| Wellfleet eligibility, benefit, claims, prior authorization, utilization review and case management inquiries |
Phone: (833) 302-9785 |
| Wellfleet Case Management Request |
Phone: (833) 302-9785 |
| Wellfleet Rx/Express Scripts |
Customer Service Phone: (877) 640-7940 Prior-Authorization Phone: (877) 640-7938 |
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Blue Shield of California Credentialing Status and Inquiries Please see this guide for more information about the credentialing process. |
Phone: (800) 258-3091, select option 3 Email credentialing paperwork to: BSCInitialApp@blueshieldca.com |
| Blue Shield of California Contracting & Rate Inquiries |
Phone: (800) 258-3091, select option 3 |
| Zelis Payments |
Phone: (877) 828-8770 or (855) 774-4392 |
How to file claims & EFT Payments
| For services in California, submit claims to Blue Shield of California PPO Network. |
Electronic Submission via EDI See this guide for information on Electronic Data Exchange claim submission. Paper Claim Mailing Address: Blue Shield of California |
| For services outside California, submit claims to Cigna PPO Network. |
Electronic Submission via EDI Paper Claim Mailing Address: Cigna |
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Electronic Funds Transfer (EFT) Claim Payments After receiving the first paper check issued by Wellfleet/HealthComp, providers may register on the Zelis website by clicking on “Provider Login”. Providers may also contact Zelis at (877) 828-8770 or (855) 774-4392 (8am–7pm EST) to register or for questions and website issues. |
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How to make address or TIN updates with Wellfleet and Blue Shield
| Mailing Address | Submit current W9 and letter containing the updated mailing address to HealthComp at HCNetAdminW9@healthcomp.com and Blue Shield at bscproviderinfo@blueshield.com |
| Physical Address |
Submit updated W9 to HCNetAdminW9@healthcomp.com and |
| Taxpayer Identification Number (TIN) |
Submit updated W9 to HCNetAdminW9@healthcomp.com and |