Inpatient transfers between acute care hospitals/facilities
Date Issued: 4/29/2019
When a hospital or acute care facility does not have the services to ensure safe and/or quality care, it is the responsibility of the referring facility to contact the managing entity for all patient transfer requests by calling or faxing the applicable organization listed below:
EmblemHealth for HIP members
EmblemHealth for Non-City of New York members and GHI retirees
GHI PPO City of New York members and non-Medicare eligible retirees with GHI PPO benefits, contact Empire BCBS
HealthCare Partners (HCP)-managed members
Montefiore (CMO)-managed members
When contacting us, please have the following information available:
- Member ID number
- Member name
- Name of hospital/acute care facility accepting patient
- Name of physician accepting patient (from accepting hospital)
- Name of physician transferring care (from transferring hospital)
- Name of referring hospital/acute care facility
- Reason for transfer
For EmblemHealth-managed HIP and GHI members, a concurrent review nurse will review and refer all requests to an EmblemHealth Medical Director for a determination based on the clinical urgency of the specific situation. A decision will be made within one (1) business day, or in the case of a weekend on the same day of receiving all requested information. If the transfer request is approved, the concurrent review nurse will contact the transferring facility and issue a case number for the transfer.
It is the accepting hospital/acute care facility’s responsibility to confirm the transfer is authorized and to obtain the case number from the transferring facility. To receive payment, the accepting facility must include the case number on all associated claim submissions.
If the request for the transfer is denied, refer to the applicable Dispute Resolution chapter – Commercial, Medicaid, or Medicare.