Medica Administrative Manual > Health Management and Quality Improvement > Care Management > Transplant Case Management

Transplant Case Management

Case managers assess, educate and coordinate with members with the goal that members receive the right care at the right place at the right time. This includes guiding members to the best-in-class location for the type of transplant they need, utilizing Medica or Optum designated transplant centers through the Centers of Excellence (COE) Program, assisting each member through the evaluation and listing process, helping them maintain transplant readiness while awaiting organ transplant, and providing any needed post-transplant follow-up.

Transplant case managers complete both utilization management and case management functions to provide members with a consistent, integrated relationship with Medica through the continuum of care.

See additional information regarding Centers of Excellence.

All transplant services, except for corneas, require prior authorization. For more information, review the utilization management policies and forms. For CAR-T services, please submit prior authorization requests directly through our specialty pharmacy administrator. If there are additional questions, please call Medica Provider Services at 1 (800) 458-5512.

For questions regarding transplant services, refer to Medica's medical policies, or call Medica Case Management at 1 (866) 905-7430 or email us.

REV 1/2024