| Applies To |
All transplant-related services rendered by a credentialed
Faculty member regardless of the department or specialty
(i.e. BMT patient requiring consult with cardiology, urology,
etc.) as part of the evaluation, maintenance process leading
up to transplant, the transplant admission and post-
transplant services if applicable.
Note: Completion of credentialing by UT Southwestern does not constitute active participation for this particular network. Physicians must meet it's required criteria in order to be accepted.
|
| Transplant Programs |
Adult Bone Marrow/Stem Cell Transplant Only |
| Laboratory Services |
All authorized transplant laboratory services are covered |
| Radiology Services |
All authorized transplant radiology services are covered |
| Participating Facilities |
Zale Lipshy University Hospital |
| Authorization Requirements |
- Call 1-877-212-8811
- Precertification prior to transplant evaluation is required for transplant evaluation, transplant, re-transpantation and all confinements that occur during the wait list or post transplant period.
- An approval letter for the evaluation will be sent to the Transplant Facility, PCP and member. This letter provides the dates of authorization and the authorization number for the evaluation phase.
- A decision regarding the medical appropriateness of the transplant will occur following the evaluation. A letter outlining the determination will be sent to the Transplant Facility, PCP and member.
Phases
- Evaluation Phase - Included in the Transplant Global Phase. Services required for assessment, evaluation and acceptance into program. Ends at time member is determined to be an appropriate candidate for transplantation.
- Pre-Transplant Phase - Begins after acceptance into program and ends at start of Transplant phase. Note: Some services in the Pre-Transplant phase may default to the general services agreement. Contact Managed Care Contracting for questions.
- Transplant Phase - Myeloablative - 1st day of high dose chemotherapy or total body radiation therapy. Non-Myeloablative - day of admit for transplant. Also includes HLA typing, mobilization, harvesting, stimulating factors, pheresis, storage and chemotheraphy agents for non-myeloablative procedures.
- Post-Transplant Phase - 180 days after discharge from transplant admit.
|
| Managed Care Plan |
Aetna NME:
HMO, PPO, POS, EPO |
| FSC |
826 |
| Contract Date(s) |
August 1, 2002 |
| Claims Mailing Address |
Aetna Inc.
National Transplant Claim Unit
P.O. Box 9607
One Farr View Rd.
Cranbury, NJ 08512
|
| Deductible/Copayments |
Verify benefits at phone number listed on insurance ID card. |
| Claims Submission |
All claims for services covered under the Transplant agreement must be bundle billed with the facility claims. Facility requires bundle billing to be submitted within 60 days of discharge from the Transplant admission. |
| Appeals |
Appeal request must be submitted to payor within 180 days of the processing date on the EOB or the date of the denial letter. |
| Case Management Contacts |
Mary Foote
National Contractor
(281) 637-3155 |
