QUEST Integration - Organ Transplants - Donor Services

This information applies to services provided to organ transplant donors. For information on transplants, see QUEST Integration - Organ Transplants.

• Services related to donors are covered only if the organ recipient is an HMSA QUEST Integration member and the transplant is covered by HMSA's Plan for QUEST Integration Members.
• If donors are covered under another medical plan, that plan is primary, and its benefits must be applied first.
• Benefits for the screening of donors include payment of only those expenses associated with the actual donor.  Expenses associated with the screening of other donor candidates are not a benefit.

Claims Filing Information

• When the actual organ donor is covered by his or her own medical plan, bill the donor's health insurance plan.
• When the donor is a QUEST Integration member and has another insurance plan, bill the other insurance first.
• If the donor is a QUEST Integration member with no other insurance, submit a QUEST Integration claim to the donor's QUEST Integration medical plan.
• If the donor has no insurance, claims may be filed under the organ recipient's QUEST Integration member number. Enter the organ recipient's name in block #4 of the CMS 1500 claim form, and the words "organ donor" in block #19.
• The recipient's HMSA member ID number should appear in Block 1A of the CMS 1500 claim form.
• The recipient's name should appear in Blocks 2 and 4.
• The donor's name and the word "donor" should appear in Block 19. If the donor is anonymous, write "anonymous."

Precertification

• Precertification is not required for donor pre-testing, e.g., crossmatch work-up for transplants covered under QUEST Integration.
• Harvesting of organs requires precertification.

Revision History