DRG Inpatient Facility Transfers
Defines Anthem Ohio Medicaid reimbursement when a member is transferred between acute care facilities during the same episode of care; applies to sending and receiving facilities submitting claims to Anthem Blue Cross and Blue Shield Medicaid (Ohio Medicaid Managed Care).
08/18/2025 - Review approved: no changes
07/07/2023 - Review approved: no changes
02/01/2023 - Initial approval and effective
Inpatient Transfer Coverage
Inpatient facility transfer reimbursement criteria
Covered when ALL of the following are met:
ALL of the following
- Both sending and receiving acute care facilities are eligible for payment when a member is admitted to one acute care facility and subsequently transferred to another acute care facility for the same episode of care, unless provider, state, federal, or CMS contracts and/or requirements indicate otherwise.
- Both sending and receiving facilities will be reimbursed at a per diem rate.
- The transferring claim must use the appropriate discharge status code to indicate the member was transferred from one acute care facility to another.
- This policy was developed with consideration of CMS, state contract, and state Medicaid requirements which may affect applicability or override this policy.
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