Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.31
    OpenPayerPolicy UpdatesEmergency & Medical TransportationCareSource Georgia Transfer Policy Update | OpenPa…
    Ask Trek AI about this page
    CurrentCareSource GeorgiaPolicy MP-MM-1448

    Non-Emergency Facility to Facility Transfers

    Customize your policy alerts

    Sign up for CareSource Georgia Policy MP-MM-1448 alerts

    Get alerted when Policy MP-MM-1448 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    This policy governs coverage and medical necessity review requirements for non-emergency transfers between healthcare facilities, including transfers to obtain unavailable levels of care, diagnostic or therapeutic services, or specialist services. It applies to participating and non-participating facilities and identifies transfers that do and do not require review.

    Policy Summary
    PayerCareSource Georgia
    PolicyNon-Emergency Facility to Facility Transfers
    Policy CodePolicy MP-MM-1448
    Change TypeRevised
    Effective DateNov 1, 2026
    Last ReviewNov 5, 2025
    Next Review DateN/A
    Key ActionFor applicable non-emergency transfers, the receiving facility must submit a medical necessity review request to CareSource.
    SourceLink
    POLICY UPDATE CHANGES

    The policy replaced prior authorization with medical necessity review for applicable non-emergency transfers.

    4Applicable Marketplace states
    3Transfer types requiring review
    2Transfer types not requiring review
    6Qualifying transfer circumstances

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    2Non-covered elective-transfer conditions

    Non-Emergency Transfer Coverage Criteria

    Transfers Requiring Medical Necessity Review

    The following non-emergency transfers require a medical necessity review. For these transfers, the receiving facility submits the medical necessity review request to CareSource.

    ONE of the following transfer arrangements

    • A non-emergency transfer from a participating inpatient facility to a participating inpatient facility that is not within the same healthcare system.
    • A non-emergency transfer from a non-participating facility to a participating facility.
    • A non-emergency transfer from a non-participating facility to a non-participating facility.

    Medical Necessity Criteria

    Requests for transfers requiring medical necessity review must meet ALL of the following criteria:

    ALL of the following

    • The member is medically stable for transfer.

    • ONE or more of the following situations applies

      • The member requires transfer to a level of care that is not available at the originating facility.
      • The member requires transfer for a medically necessary diagnostic or therapeutic service that is not available at the originating facility.
      • The member requires transfer for services of a specialist to evaluate, diagnose, or treat the member's condition when that specialist is not available at the originating facility.
      • The member requires transfer because the member received care at a specific prior institution for a condition not normally managed at the originating facility, and return to that prior institution is needed to diagnose, manage, or treat a complication or other acute issue.

    Non-emergency (elective) transfers are not a covered service when the medical necessity criteria in this section have not been met.

    Non-emergency (elective) transfers are not a covered service when the transfer is performed for the convenience of the member, the member's family, the physician, or the originating facility.

    Transfer, admission, and subsequent care at the receiving facility are not medically necessary when the needed care is available at the originating facility.

    For an elective transfer to qualify for coverage, the member must be medically stable for transfer and at least one qualifying circumstance must apply, including an unavailable level of care, diagnostic or therapeutic service, or specialist; return to a prior institution for an acute issue or complication; improvement of the member's health and welfare; or the qualifying parent-to-neonate circumstance. Transfers lacking either medical stability or a qualifying circumstance are not covered.

    Review Submission and Coverage Risks

    Prior Authorization

    Receiving facility must submit review request

    For applicable non-emergency transfers, the receiving facility must submit the medical necessity review request to CareSource. Medical necessity review replaced prior authorization for these transfers.

    Denial Risk

    Avoid non-covered elective transfers

    A non-emergency elective transfer is not a covered service when the medical-necessity criteria have not been met or when the transfer is for the convenience of the member, the member’s family, the physician, or the originating facility.

    • Confirm that the member is medically stable for transfer.
    • Confirm that at least one qualifying medical-necessity situation applies.

    Policy Scope and Context

    This policy addresses transfers to a second acute care facility when the required care is unavailable at the originating facility. The goal is to maintain the patient’s optimal health by transferring the patient to the nearest facility that provides the highest level of specialized care needed. Transfer planning should support continuity of care, including pre-transfer stabilization and preparation, selection of the appropriate transport mode, accompanying personnel, required equipment and monitoring, and communication, documentation, and handoff at the receiving facility.

    Key Transfer Definitions

    Inter-Facility Transfer
    DefinitionThe transfer of patients between two healthcare facilities.
    Intra-Facility Transfer
    DefinitionThe transfer of patients within the same facility.
    Non-Emergency
    DefinitionA situation for which immediate response is not needed for the provision of medical treatment.
    Non-Participating (Out-of-Network) Facility
    Definition
    Policy Summary
    PayerCareSource Georgia
    PolicyNon-Emergency Facility to Facility Transfers
    Policy CodePolicy MP-MM-1448
    Change TypeRevised
    Effective DateNov 1, 2026
    Last ReviewNov 5, 2025
    Next Review DateN/A
    Key ActionFor applicable non-emergency transfers, the receiving facility must submit a medical necessity review request to CareSource.
    SourceLink
    On This Page
    Non-Emergency Transfer Coverage CriteriaReview Submission and Coverage RisksPolicy Scope and ContextKey Transfer Definitions
    The member requires transfer to improve the member's health and welfare, such as parental bonding.
  1. The transfer allows a parent who gave birth to remain with a neonate when the neonate's transfer meets the medically necessary criteria above and the parent requires continued hospitalization due to birth complications or other medically necessary conditions.
    2. Denial Risk

    Verify needed care is unavailable locally

    Transfer, admission, and subsequent care at the receiving facility are not medically necessary when the needed care is available at the originating facility. Transfer must be supported by unavailable care, a medically necessary service, or another qualifying circumstance under the policy.

    A facility that is not contracted with CareSource.
    Originating Facility
    DefinitionThe current facility to which an individual has been admitted for care and from which a transfer is planned.
    Participating (In-Network) Facility
    DefinitionA facility that is contracted with CareSource.
    Receiving Facility
    DefinitionThe facility to which a transfer is planned.