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 6 months. Coverage periods exceeding 6 months 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 you need to use a locum tenens physician for less than 60 days, 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).

Locum tenens, 60 days to 6 months

If your office or facility needs to use a locum tenens physician for more than 60 days, mail or fax Priority Health Provider Contracting with the information listed below on the locum tenens provider in writing, at least 30 days in advance.

When this information is complete, the provider will be identified in the Priority Health claims payment system as locum tenens and will not be loaded or maintained in the Credentialing computer system.

• The physician's name, date of birth and social security number
• A start and end date the locum tenens physician will be providing service
• A description of the services the locum tenens physician will be providing
• Current Curriculum vitae of locum tenens provider
• Copy of valid Michigan Physician and Controlled Substance licenses, and DEA certificate (as applicable)
• Copy of malpractice insurance coverage meeting Priority Health limit requirements of $100,000 per occurrence and $300,000 aggregate
• Copy of board certification confirmation, or letter
• Completed W-9 Form.

Priority Health may check, upon its discretion, the validity of certain items such as:

• Licenses
• Query with National Practitioner Data Bank
• Board certification
• Federation of State Medical Boards

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

1. 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 6 months will be processed through the Credentialing process.
2. 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.
3. 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.
4. 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.
5. 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.
6. Locum tenens providers used by participating providers must agree to accept Priority Health established reimbursement, and any other stipulations as desired by Priority Health.