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July 2013

Contact Medicare Advantage Provider Inquiry regarding human organ transplant procedures

We’re providing you with a new contact for questions about Blue Cross Blue Shield of Michigan human organ transplant procedures covered by our Medicare Plus Blue PPOSM and Medicare Plus Blue Group PPOSM products.

Our Human Organ Transplant Program is no longer managing transplant benefits for our Medicare Advantage members. If you have questions about the benefit, you should now call the Blue Cross Medicare Advantage Provider Inquiry department at 1-866-309-1719. This transition occurred on June 1, 2013.

It’s also important to note:

  • Each relevant transplant procedure must be performed in a Medicare-approved facility.
  • Medicare Advantage members aren’t required to use Blue Distinction Centers® for Transplant. Also, that designation doesn’t guarantee Medicare approval.
  • Preauthorization isn’t required for transplant procedures covered by Original Medicare or by optional, enhanced Medicare Plus Blue Group PPO benefits.
  • For case management help, transplant facilities should refer Medicare Advantage members to the Blue Cross Case Management Program by calling 1-800-845-5982.

Helping members manage transplant procedures
The following information will help you talk with patients about Blue Cross human organ transplant procedures:

  • Members with coverage questions about transplant procedures should call the Customer Service number on the back of their ID cards.
  • Medicare Advantage groups have the option of purchasing enhanced organ transplant coverage that involves diagnoses and procedures that may not be covered in Original Medicare. Medicare Advantage group members should refer to their Evidence of Coverage or contact Customer Service to find out if they have expanded coverage.
  • Some Medicare Advantage group members have coverage for travel and lodging related to transplant services. Customer Service can also provide information about that benefit.
  • A member’s cost-sharing amount is determined by the group. All services must be provided during the benefit period, except for anti-rejection drugs and other transplant-related prescription drugs. The benefit period begins five days before the transplant and ends one year after the transplant.

When directly related to a covered transplant, Medicare Advantage will pay for anti-rejection drugs and other transplant-related prescription drugs — during and after the benefit period.  For noncovered transplants, the member’s prescription drug plan is responsible for anti-rejection drugs and other transplant-related prescription drugs.

If you would like more information about procedures included in the enhanced transplant benefit, visit BCBSM’s Newsletters & Resources Medicare Advantage Resources page.

Here’s how to find it:

  1. Go to bcbsm.com.
  2. Click on LOGIN and select Provider.
  3. Log in to Provider Secured Services.
  4. Click on web-DENIS.
  5. Click on BCBSM Provider Publications and Resources.
  6. Click on Newsletters & Resources.
  7. Click on Medicare Advantage.
  8. Click on Human organ transplants: Enhanced benefit transplant procedures.
No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2012 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
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