CG-ANC-07 Inpatient Interfacility Transfers

This policy addresses inpatient interfacility hospital transfers between an originating facility and a receiving facility. Transfers (and the receiving facility admission) are covered as medically necessary when the patient needs a diagnostic/therapeutic service, higher level of care (for example, NICU or Level I trauma), or a specialist not available in a timely manner at the originating facility, or when the condition is not typically managed there; they are not covered when these criteria are not met or when driven by convenience of the patient, family, physician, or facility. Key limitations: timeliness of specialist availability is case-specific, services must be unavailable at the originating facility, and both the transfer and the subsequent admission are subject to the same medical necessity criteria.

"Interfacility transfers are consideredmedically necessarywhenone or moreof the following criteria are met:"