Transplant Services Prior Authorization Request Form

Streamline Transplant Services Prior Authorization with Paperform

Securing prior authorization for transplant services is one of the most complex processes in healthcare administration. Between coordinating with UNOS listings, documenting donor matching criteria, gathering multidisciplinary team evaluations, and meeting stringent insurance requirements, transplant coordinators face an administrative burden that can delay life-saving care.

This Transplant Services Prior Authorization Request Form template is designed specifically for transplant centers, hospital systems, and healthcare providers who need to submit comprehensive, accurate prior authorization requests to insurance carriers for organ transplant procedures.

Built for the complexity of transplant authorization

Unlike generic medical authorization forms, this template captures the specialized information payers require for transplant approval: UNOS registration details, recipient clinical status, donor compatibility factors, immunosuppression protocols, and the coordinated assessments from nephrology, cardiology, surgery, psychiatry, social work, and other specialists on your multidisciplinary team.

The form guides coordinators through each required section—from patient demographics and insurance verification through clinical necessity documentation and post-transplant care planning—ensuring nothing is missed before submission.

Reduce errors and speed up approvals

With conditional logic built in, the form adapts based on transplant type (kidney, liver, heart, lung, pancreas, or multi-organ), showing only relevant clinical questions and required documentation. Required fields ensure coordinators can't submit incomplete requests, and calculated fields can auto-populate MELD scores, CPRA percentages, or other clinical indicators when values are entered.

Once submitted, you can route the request through Stepper (stepper.io) to automatically notify medical directors for review, push data into your EMR or case management system, send confirmation emails to the insurance carrier, and create follow-up tasks for your team—all without manual data entry.

Professional, compliant, and ready to customize

This template follows standard prior authorization formatting expected by major payers, while remaining fully customizable to match your institution's protocols, branding, and specific payer requirements. Upload supporting documentation (lab results, imaging, psychosocial evaluations, financial clearance) directly within the form, keeping everything organized in one submission.

Paperform is SOC 2 Type II certified and GDPR compliant, providing the security and audit trails healthcare organizations require. While Paperform is not HIPAA compliant, it offers robust data protection suitable for administrative workflows where PHI handling is managed according to your organization's policies.

Whether you're a transplant coordinator at a large medical center or part of a regional transplant network, this template helps you submit complete, accurate prior authorization requests faster—so your patients can get the approvals they need without unnecessary delays.

Get started with this template and customize it to fit your transplant program's workflow, then connect it to your existing systems using Paperform's healthcare integrations and Stepper automation.