New prior authorization requirement: Kidney transplantation
Effective August 1, 2021, the following Anthem Blue Cross and Blue Shield (Anthem) clinical guideline will be implemented and will require prior authorization for Indiana, Kentucky, Missouri, Ohio and Wisconsin.
CG-TRANS-02 Kidney Transplantation
This guideline addresses kidney transplantation, involving the removal of the kidney from a deceased or living donor with the implantation into a single recipient.
This requirement applies to Commercial members covered by Anthem Blue products, consumer-driven health plans (CDHP), and Traditional products in Indiana, Kentucky, Missouri, Ohio and Wisconsin.
Determine if prior authorization is needed for an Anthem member by going to anthem.com > select “Providers” > under “Claims” > select “Prior Authorization”, then select your state. Or, you may call the prior authorization phone number on the back of the member’s ID card.
May 2021 Anthem Provider News - Missouri