Non-emergent ambulance transfers of admitted patients between hospitals must be pre-approved by Independence Blue Cross for their members.

 

By Christine C. Stallkamp, MD FAAFP, System medical Ddirector, Revenue Integrity and Care Coordination

 

Effective 6/1/2019, IBC stated that they will require pre-certifications for any of their patients travelling between acute care hospitals for non-emergent needs. This means that patients who need to be transferred for continuity of care with their PCP, specialist or surgeon must first get this approval, and it applies to transfers between our own MLH hospitals. The transfer center will attempt to obtain the approval on your behalf.  This may cause a delay in transfer for these patients, especially on nights and weekends outside of IBC’s typical business hours.

 

If you have a patient that is denied approval by IBC for an ambulance transfer, and you feel that this decision is clinically inappropriate or is detrimental to the care of the patient (for example, oncology care at Jefferson with a cancer-related complication, or recent orthopedic surgery at Crozer with a surgical complication), please let the transfer center know and the UM physician team can assist you in obtaining a Peer to Peer appeal phone call with the IBC medical director.  Please note that even if the patient is willing to “self-pay” out of pocket for the ambulance transfer, the hospitalization will still require a precertification/approval from IBC.

This entry was posted in Clinician News and tagged . Bookmark the permalink.

Leave a Reply

Your email address will not be published. Required fields are marked *