Transplants undergo standard BCN clinical review process effective April 1, 2015

Effective with requests submitted on or after April 1, 2015, transplants that require clinical review are subject to the standard clinical review process managed by BCN Care Management staff. Prior to April 1, clinical review was completed by a BCN case manager. This change applies to solid organ and bone marrow evaluations and harvesting (except kidney, skin and cornea), for all members. This also applies to requests to renew or extend an authorization period if the transplant procedure does not occur within the time frame allowed by the authorization.

The preferred method for requesting clinical review is to submit the request through BCN's e-referral system. You can also call in the request to Care Management at 1-800-392-2512. Clinical documentation should be faxed to 1-800-675-7278.

In addition, as a reminder, BCN HMO^SM(commercial) members are required to have their transplants performed at a Blue Distinction^® Center+ for Transplants, if one is available. This requirement is effective May 1, 2015. In Michigan, the only facility that has achieved the Blue Distinction Center+ for Transplants designation is the University of Michigan Hospital System (for most, but not all, types of transplants). If a Blue Distinction Center+ for Transplants facility is not available for the type of transplant the member needs, a Blue Distinction Center for Transplants facility may be used.

BCN Advantage^SM members are required to have their transplants performed in facilities that are approved by the Centers for Medicare & Medicaid Services and are contracted with BCN Advantage. It's preferred that BCN Advantage members be directed to a Blue Distinction Center for Transplants, when one is available.

For additional information, see the article "BCN updates transplant policy for Blue Distinction Centers" in the March-April 2015 issue of BCN Provider News.