Ch 11: Locum Tenens

Who is a locum tenens provider?

A locum tenens provider is a provider who is sponsored by or otherwise retained by a VHP contracted provider on a temporary basis, not to exceed 60 calendar days, to provide services to the contracted provider’s patients. The contracted provider must be currently employed at that location.

VHP does not contract with or make any representation regarding a locum tenens provider’s qualifications or competency. All liability for the acts or omissions of a locum tenens provider rests with the provider or organization retaining the services of the locum tenens.

The locum tenens must be the same type of provider as the authorizing provider (e.g., an MD/DO can only authorize another MD/DO as a locum tenens, a DC can only authorize another DC, etc.). To be considered for locum tenens status, the temporary provider must be one of the following provider types:

Doctor of Medicine (MD) Doctor of Podiatry (DPM) Doctor of Optometry (OD) Doctor of Osteopathy (DO) Doctor of Chiropractic (DC) Physical Therapist (PT)

Temporary Transfer of Responsibility

Provider agreements obligate PCPs to establish and maintain coverage 24 hours a day, seven days a week. However, personal illness, sabbatical or maternity leave are examples of times when brief withdrawal from a practice and temporary transfer of this responsibility may be necessary. In the event the provider must withdraw from his/her practice for a planned period of time (e.g., maternity leave), VHP, at its discretion, may agree that a locum tenens provider may be engaged by the PCP to provide coverage for a limited and specified period of time. The provider must arrange for this coverage and provide VHP with written notice of the temporary transfer of responsibility to a locum tenens provider acceptable to VHP.

The provider requesting a temporary transfer of responsibility must include in the arrangement with the locum tenens provider the ability to terminate, without cause and effective upon notice, the locum tenens provider’s provision of services with respect to VHP’s members. If the intended interruption will exceed 60 calendar days, VHP may close the provider’s panel, since absence beyond 60 calendar days does not allow for direct patient management. Sustained periods of unavailability are not in the best interest of VHP’s members, as members are unable to access their chosen PCP. If a PCP’s temporary transfer of responsibility extends beyond 60 calendar days and involves unique circumstances, the provider requesting temporary transfer of responsibility must contact the Provider Credentialing Department for further guidance at 1.408.885.2221 or credentialing@vhp.sccgov.org.

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Locum tenens providers will not be listed in the VHP Provider Directory and are not permitted to have a panel of members.

How to Submit Claims for Rendered Services

Locum tenens providers must bill for their services under the name and tax identification number (TIN) of the provider the locum tenens is replacing. However, the locum tenens provider must provide their National Provider Identifier (NPI) number. Locum tenens providers must be licensed in the state in which they are practicing and must only perform services within the scope of their professional license and certification.

When billing for rendered services as a locum tenens, the provider should use the modifier for substitute Physician (Q5), and locum tenens (Q6) as a covering provider.

Note: If a provider organization plans to utilize a locum tenens for a period of 60 calendar days or longer, the locum tenens provider must be credentialed by VHP. The contracted provider must notify VHP prior to commencement of the use of the locum tenens, if possible, and if not possible, then immediately notify VHP to allow sufficient time for the credentialing process.

Covering Provider

A covering provider is responsible for emergent or urgent care only. Follow-up treatment must always occur with the member’s PCP or a VHP specialist. All VHP providers have contractually agreed to be accessible to members 24 hours per day, seven days per week. If a provider is not available, the provider is responsible for maintaining appropriate coverage. VHP requires that all covering providers be contracted and credentialed. A written notification of the termination or addition of covering providers must be sent to Provider Data Management 30 calendar days prior to the start or termination of the provider by calling 1.408.885.2566 or emailing providerdatamgt@vhp.sccgov.org.

VHP requires that covering providers with the potential to treat VHP members be enrolled and credentialed. Enrollment and credentialing will be valid for up to six months.

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CH 12: Timely Access Requirements

This Chapter Includes:

1. Timely Access Standards 2. Exceptions to Time-Elapsed Standards 3. Triage and Screening Services 4. Nurse Advice Line

5. Timely Access Monitoring

Alert

Alert draws attention to critical information that has changed this year.

Contact

Contact information on who to contact for assistance.

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