A locum tenens provider is defined as a physician filling in for a specified time or temporarily taking the place of another physician for a period of less than 60 days. Coverage periods exceeding 60 days do not qualify for locum tenens status. 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.
Locum tenens, less than 60 days
If your office or facility needs to use a locum tenens physician for less than 60 days, provisional credentialing is required. You may bill for services with the Q6 modifier. Note: Per Medicare guidelines, the Q6 modifier may not be used by a Certified Registered Nurse Anesthetist (CRNA).
Provisional credentialing for Locum tenens, less than 60 days
If your office or facility needs to use a locum tenens physician for less than 60 days, a provider enrollment application must be submitted through our prism provider portal, at least 30 days in advance, to provisionally credential and enroll the locum tenens.
Priority Health may check, upon its discretion, the validity of certain items such as:
- Licenses
- Query with National Practitioner Data Bank
- Sanctions, exclusions, preclusions or debarment
Priority Health locum tenens policy
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 that has a short-term need for specific services. Locum tenens providing services to Priority Health members for longer than 60 days will be processed through the Credentialing process.
- Credentialing of locum tenens by Priority Health is required under NCQA Credentialing standards. Therefore, Priority Health assumes responsibility for the provisional credentialing of locum tenens providers who work less than 60 days and are 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 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, the 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 established reimbursement, and any other stipulations as desired by Priority Health.