CommercialPrior AuthMedium impact
Heart Transplant
Blue Cross & Blue Shield of Mississippi·MS · Cardiology, Cardiothoracic Surgery, Critical Care·Medical Policy
We identified it
Jun 20, 2026
Summary
Blue Cross & Blue Shield of Mississippi updated their heart transplant policy requiring prior authorization through case management for all covered transplant procedures. The policy establishes specific medical necessity criteria for adult and pediatric patients with end-stage heart failure, including pulmonary/liver/renal status requirements and detailed selection guidelines.
Action Required
Immediately: Billing team must ensure prior authorization is obtained through case management from Blue Cross & Blue Shield of Mississippi before scheduling or billing for any heart transplant procedures. Update billing system to flag heart transplant cases for prior auth requirement. Providers must document compliance with the specific medical necessity criteria including adequate organ function, absence of contraindications, and patient selection guidelines. Claims will be denied without proper prior authorization.