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Q&A: Blue Shield of California as the State of California’s Third-Party Administrator

Blue Shield of California is a nonprofit health plan whose goal is to help ensure all Californians have access to health care that is worthy of our family and friends and sustainably affordable.

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The Oakland, Calif.-based company answered the state’s call to assist its efforts to save lives by helping to end the COVID-19 pandemic through a vaccination effort that reaches every corner of our state, especially those communities hardest hit by this global public health crisis. 

To meet that goal, Blue Shield is acting as the state of California’s Third-Party Administrator (TPA) to manage the state’s enhanced vaccine provider network. This will provide a single, California-wide system for managing the allocation and administration of vaccine throughout the state. The transition from the state’s existing provider network to the enhanced network will occur in three phases through the end of March.

The effort is a key part of the state’s goal of having the capacity to provide 4 million vaccinations a week. Blue Shield is providing this support at cost and will not profit from the state. 

Because this network is new to California residents, people have had many questions about what it is and how it works. Below are frequently asked questions and their answers. 

Why is the enhanced network important?

A single statewide network is crucial to creating an effective, safe, efficient and equitable vaccine allocation and administration system for all Californians. This unified network provides four vital benefits for the state: 

  • It allows the state to know where vaccine doses are on their entire journey from shipment to shot, minimizing waste and providing more accurate data to maximize the supply of vaccines that California receives from the Centers for Disease Control and Prevention (CDC). 
  • It enables providers to have greater predictability of how much vaccine each of them will receive in the coming weeks allowing them to plan appointments effectively and minimize cancelled or delayed appointments.
  • It means California can meet its equity pledge by considering the needs of the entire state when it comes to allocations, ensuring the vaccine reaches the individuals and communities hardest hit by the pandemic.
  • California residents will now have a single point of contact for all communications about vaccine allocation and administration, improving education and information about access to the vaccine.  

What is a Third-Party Administrator (TPA) and what is Blue Shield’s role as the state’s TPA?

The Third-Party Administrator is the entity the state of California has assigned to organize and manage the vaccine provider network on behalf of, and under the direction of, the state and its public health officials. The TPA is responsible for enrolling providers, lending support in the state’s vaccine allocation efforts, tracking vaccines, and collecting data the state needs to measure the efficiency, effectiveness and equity of its vaccination effort. 

Why was Blue Shield of California chosen to be the TPA?

Blue Shield of California is a California-based nonprofit health plan with a provider network that covers all 58 counties in the state, and it is the only health plan on Covered California that has a PPO network covering every residential zip code in the state. Blue Shield has a history of working as a health plan administrator for large employers including large state accounts. The TPA contract is clear that there is no financial gain by Blue Shield for its efforts in this vaccine program. In fact, Blue Shield is not charging the state for its staff time devoted to this effort. Blue Shield will only bill the state actual expenses to support the vaccine network.

Who makes decisions on allocation, on how many doses of vaccine will each provider get?

California’s public health officials are responsible for making those decisions. They choose the criteria and design the formula for allocating available doses the state receives every week from the federal government. Blue Shield, as the TPA, applies those state directives to help manage the allocation of the doses to each provider enrolled in the network. The network tracks the location of each dose throughout the network and reports this information back to the state.

What happens if my county chooses not to sign an agreement with the TPA? Does that change their vaccine allocation?

The state determines vaccine allocation, and the TPA is to carry out the state’s directives. It is important to note that during the transition period (month of March) to the enhanced network, providers that are already administering the vaccine will continue to receive doses, especially to ensure people who have had their first vaccine dose of a two-dose vaccine like Pfizer or Moderna are able to get their second dose. 

How does the network account for people who don’t have access to things like computers or smart phones – how can they sign up for vaccines?

The state’s My Turn system is the one-stop service for vaccine appointments. It can be used online, but Californians who don’t have online access may also call 1-833-422-4255 and speak to an agent who can help. In some instances, providers may offer an in-person service for people to sign up.

How does the network serve Californians who have limited mobility or otherwise have difficulty going to a central location to be vaccinated? 

We are working with various providers to integrate ways to get vaccines to people and communities who are unable to travel to a provider or a mass vaccination site – that includes things like local pop-up sites, mobile vaccination units, in-home vaccinations, or bringing vaccine clinics directly to farmworkers. Some of these are already working and we will announce more as soon as they are available.

For the latest on California’s Enhanced COVID-19 Provider Network click here

Blue Shield of California President and CEO Paul Markovich spoke March 12 with news media about the nonprofit health plan’s ongoing support for the state’s COVID-19 vaccination efforts as the state’s third-party administrator. Watch here.