CommercialPrior AuthMedium impact
Learn more about prior authorization process for Human Organ Transplant program
BCBS Michigan·MI · Transplant Surgery, General Surgery·Prior Authorization
Effective date
Aug 1, 2026
We identified it
Jul 23, 2026
Summary
Blue Cross Blue Shield of Michigan has published updated prior authorization procedures for their Human Organ Transplant program. The policy clarifies PA requirements for solid organ and bone marrow transplants for commercial members, while exempting cornea transplants, kidney transplants for self-funded groups, and skin transplants from prior authorization. A new detailed document on the Transplant Services page outlines steps for submitting outpatient PA requests, inpatient admission PAs, extensions, reauthorizations, and reconsideration reviews.
Action Required
By August 1, 2026: Billing team and transplant financial coordinators must review the new prior authorization procedures document on authorizations.bcbsm.com/Transplant Services page. Update internal workflows to implement the new PA submission requirements for inpatient solid organ and bone marrow transplant procedures for commercial members. Ensure all transplant coordinators understand exemptions: cornea transplants, kidney transplants for self-funded groups, and skin transplants do NOT require prior authorization. Train staff on proper timing for outpatient PA requests versus inpatient PA requests at time of admission. Establish process for tracking extension, reauthorization, and reconsideration requests per new guidelines. Failure to follow updated procedures may result in claim denials for transplant procedures.