Starting Nov. 1, changes in authorizing human organ transplants for BCN members
Starting Nov. 1, 2019, some changes will occur in the process of authorizing human organ transplants for BCN HMOSM and BCN AdvantageSM members.
Here's what's staying the same:
You'll continue to submit these authorization requests either through the e-referral system or by calling BCN Utilization Management at 1-800-392-2512, as you do now.
You'll continue to fax your initial clinical information to BCN Utilization Management at 1-800-675-7278, as you do now.
Here's what’s changing:
Checklist for additional clinical information, if required. If additional clinical information is needed before a determination can be made on your request, you'll receive a checklist from the corporate Human Organ Transplant Program unit. In that checklist:
You'll see the fax number to use when submitting the additional clinical information; the number is 1-866-752-5769.
You'll get the phone number for the corporate Human Organ Transplant Program unit; the number is 1-800-242-3504. You'll call that number with questions or for follow up.
Two authorization numbers. You'll receive two authorization numbers for approved requests - one for the transplant procedure and one for the inpatient stay. (Currently, you receive only one authorization number that covers both the procedure and the stay.)
Where to find the authorization numbers. Once the determination is made, you'll see both authorization numbers in the e-referral system and you'll receive a letter that will show both numbers. We will fax the letter to the person who requested the authorization. (Currently, you see one number in the e-referral system and don't receive any letters.)
Attachment A included. For approved authorizations, the letter you receive will include the Human Organ Transplant Program Attachment A: Authorization Form. This will indicate that your claim will be reimbursed with a global rate, which includes payment for both the procedure and the inpatient stay. (Currently, you don't receive this form for BCN authorizations.)
Call 1-800-242-3504. You'll call the corporate Human Organ Transplant Program unit at 1-800-242-3504 with any questions or for any follow up needed after you submit the initial authorization request. This number will be included in any faxes and letters you receive. (As noted earlier, you currently call 1-800-392-2512.)
You must initiate reauthorization after one year. If the patient does not receive the transplant within one year of the date of the initial authorization, you must request a new authorization either through the e-referral system or by calling BCN Utilization Management at 1-800-392-2512. (Currently, the reauthorization request is handled internally by BCN.)
We're working to minimize any inconvenience to you as we make changes in how we handle the human organ transplant authorization process. If you have any questions or need after-hours assistance, contact the corporate Human Organ Transplant Program unit at 1-800-242-3504.
Posted: October 2019 Line of business: Blue Care Network