Physician-initiated patient transfers

Primary care physicians (PCPs), physician groups or independent practice associations (IPAs) acting on behalf of a PCP may request that Humana transfer a patient to another PCP. In some situations, if the PCP is with an IPA or physician group, the request can be to transfer the patient to an entirely different IPA or physician group. Generally, such requests are initiated because the patient and/or power of attorney (POA) or legal guardian have engaged in behavior that is disruptive, unruly or abusive to the extent that it seriously impairs the PCP's ability to furnish services to either the patient in question or other patients.

Note: Patients cannot be discriminated against in the delivery of healthcare services, consistent with the benefits covered in their policy, based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, sexual orientation, genetic information, source of payment, health status or participation in a federal program, such as Medicare or Medicaid. Accordingly, a transfer request may not be based on any of these factors, or on the amount or cost of the service that a patient requires. This list is not all-inclusive. PCPs are responsible for complying with all laws, regulations or other standards and policies that may apply.

Before initiating a transfer request, the PCP must solicit the patient’s or the patient’s POA/legal guardian's cooperation to resolve the unfavorable situation and document the results of the discussion(s).

If this approach fails and the PCP has documentation showing that attempts at resolution were made but were unsuccessful, the PCP may initiate a request to transfer the patient to another PCP

The requirement that the PCP attempt to resolve the issue(s) may be waived by the market in situations involving threats of violence, stalking, harassment or acts of violence or aggression against the PCP or his or her office staff or other providers or their staff in an IPA/group's restricted network

Humana will evaluate, decide and process the request for patient transfers as expeditiously as possible from the date on which Humana receives a request that contains all the required information and documentation. Humana will notify the PCP whether the transfer was approved or denied. Generally, Humana does not approve transfers that are related only to a patient’s failure to receive recommended care or attend appointments.

Steps to initiate a patient transfer request:

The PCP fills out the Physician-initiated Transfer Request Form and sends it to his or her respective market designee. Please attach all relevant evidence to the case.

The market designee gathers all information and submits it to the market medical director for review.

The PCP receives a letter with the case determination within 21 business days.



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