Priority Health locum tenens policy
Policy number: Policy #2/0045/R0
Policy title:
Locum tenens policy
Policy statement
To define Priority Health's position on the use of locum tenens providers by participating providers and facilities.
Effective date: 05/18/01
Review date: New, 4/3/02 annual review, 10/1/03 annual review, 2/06 revisions
Status: Existing
Approval committee/date: Provider Network Servicing Committee
Distribution/security: All staff/no security required
Author(s): Kris Nelson and Karen Dugan
Background
Priority Health recognizes the needs of provider offices and facilities to occasionally utilize the services of locum tenens providers in such circumstances as: vacations, illness or accident, or, in the case of facilities, such circumstances as during recruitment periods or staffing shortages. Priority Health desires to appropriately reimburse locum tenens providers who are providing services to Priority Health members on a short-term basis.
Policy description
- This service is utilized by participating providers within their office setting or by a participating facility who has a short-term need for specific services.
- Credentialing of locum tenens by Priority Health is not required under NCQA Credentialing standards, and, therefore, Priority Health does not assume any responsibility for credentialing of locum tenens providers utilized by participating providers or facilities.
- In all circumstances, the ultimate responsibility for ensuring the use of an appropriately trained and qualified locum tenens provider rests with the utilizing provider or facility.
- Participating providers and facilities are required to notify Priority Health of their intended use of a locum tenens provider 30 days prior to the use of such services. Priority Health will collect certain information about the locum tenens provider to aid in the appropriate and timely reimbursement of services provided to Priority Health members.
- For those locum tenens being utilized for sixty (60) days or less, utilizing provider or facility will be instructed to bill for locum tenens services following Medicare guidelines by billing with the Q6 modifier. Per Medicare guidelines, the Q6 modifier may not be used by a Certified Registered Nurse Anesthetist (CRNA). Any locum tenens who is utilized for greater than sixty days will follow the requirements of this policy and corresponding procedure.
- Locum tenens providers used by participating providers must agree to accept Priority Health?TMs established reimbursement, and any other stipulations as desired by Priority Health.
Policy review
Priority Health's locum tenens policy will be reviewed at least biennially, and revised as necessary.
Supporting documentation:
Locum tenens procedure
Operational areas impacted: Credentialing, Provider Network Services, Provider Reimbursement, Operations
Special notes (i.e., products affected): This policy applies to all products.
