Blue Care Network manages prior authorizations for solid organ and bone marrow transplant procedures for BCN commercial members through the Human Organ Transplant Program.

Notes:

• Cornea and skin transplants don’t require prior authorization.
• For BCN Advantage^SM members, transplants don’t require prior authorization through the Human Organ Transplant Program for dates of service on or after Jan. 1, 2024.

For information about transplant services for Blue Cross Blue Shield of Michigan commercial members, see the Blue Cross Transplant Services page.

How to submit prior authorization requests

To learn how to access the e-referral system to submit requests, see our Getting Started page.

For information about entering the prior authorization request for the transplant procedure, see the e-referral User Guide. The pertinent information is in "Section IV: Referrals and Authorizations," in the subsection titled "5. Submit an Outpatient Authorization."

Note: Before submitting a request for a kidney-only transplant, call the Human Organ Transplant team at 1-800-242-3504 to determine member eligibility.

Submit requests before providing services.

Resources

• Procedure codes for which providers must request prior authorization (PDF) — See this document to determine which procedure codes require prior authorization
• BCN referral and authorization requirements for Michigan providers (PDF)
• Transplants: For prior authorization determinations (PDF) — Includes information about the utilization management program
• Blue Cross and BCN medical policies — Open our Medical Policy Router Search page on bcbsm.com. Enter a procedure code in the Policy/Topic Keyword field.

Training for the the Human Organ Transplant program

We offer provider training. To learn more, see our Training Tools page.