MedicaidPrior AuthHigh impact
23-219 Follow Organ Transplant Referral and Authorization Process to Avoid Delays
Health Net·CA · Nephrology, Oncology, Hematology +5 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health has updated their organ transplant prior authorization process, requiring all transplant centers to submit requests through the Centene Centralized Transplant Unit (CTU). For Medi-Cal members under 21, transplants must be coordinated through California Children's Services (CCS), while members 21+ require prior authorization through the CTU via provider portal or fax to 833-769-1141.
Action Required
Immediately: Update organ transplant referral workflows to route all authorization requests through Centene Centralized Transplant Unit (CTU). For Medi-Cal members under 21, refer to California Children's Services (CCS) first. For members 21+, submit prior authorization requests via provider portal or fax to 833-769-1141. Billing team must verify proper authorization is obtained before proceeding with transplant-related services to avoid claim denials.