CommercialPrior AuthLow impact
Heart/Lung Transplant
Blue Cross & Blue Shield of Mississippi·MS · Cardiothoracic Surgery, Cardiology, Pulmonology +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
Blue Cross & Blue Shield of Mississippi has updated their heart/lung transplant policy, establishing specific medical necessity criteria and requiring prior authorization through case management for all covered transplant procedures. The policy defines when heart/lung transplantation is medically necessary versus investigational.
Action Required
Immediately: Billing team must ensure prior authorization is obtained through case management from Blue Cross & Blue Shield of Mississippi before scheduling any heart/lung transplant procedures. Update system to flag these cases for prior auth requirement. Claims will be denied without proper authorization.