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:

 

 

Managing Entity/Members Phone Fax
EmblemHealth for HIP members 866-447-9717 866-215-2928
EmblemHealth for Non-City of New York members and GHI retirees 800-223-9870 212-563-8391
GHI PPO City of New York members and non-Medicare eligible retirees with GHI PPO benefits, contact Empire BCBS 800-521-9574 800-241-5308
HealthCare Partners (HCP)-managed members 800-877-7587 888-746-6433
Montefiore (CMO)-managed members 888-666-8326 n/a

 

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
  • Diagnosis
  • 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 – CommercialMedicaid, or Medicare.