We’re updating the Locum Tenens Arrangements medical policy

Blue Cross Blue Shield of Michigan is updating the policy guidelines for the Locum Tenens Arrangements medical policy, effective Dec. 1, 2019.

The use of a locum tenens provider, or temporary provider, to deliver medical care in the office of a fully credentialled network provider who is unavailable due to illness, pregnancy, vacation, participation in continuing medical education or being called to active duty as a member of a reserve component of the Armed Forces is an established, longstanding and accepted practice.

Medical policy guidelines:

• Blue Cross will allow services provided by locum tenens providers to be billed under the PIN of the regular provider for up to 60 continuous days.
• If a locum tenens provider is treating Blue Cross PPO members for longer than 60 continuous days, he or she must register with Blue Cross and bill under his or her own PIN. If the locum tenens provider is treating PPO patients for longer than 60 continuous days, he or she must be credentialed in the TRUST network or out-of-network sanctions will be applied to claims. Providers who anticipate providing locum tenens services on a regular basis involving multiple practices (two or more) within a 12-month period should be credentialed in the TRUST network.
• Each covered clinical service (procedure code) delivered by the locum tenens provider under the regular provider’s PIN must be appended with either modifiers Q5 or Q6.
• Locum tenens providers must be licensed in the state in which the service is delivered and must only deliver services within their scope of practice.
• The regular provider will pay the locum tenens provider a per diem or agreed amount and the locum tenens provider won’t bill Blue Cross for the services independently.
• When a physician leaves a group, the locum tenens services may be billed using either the replaced physician’s PIN or the group PIN for up to 60 days.

Affected providers
This policy affects any fully licensed, contracted provider who is eligible for direct reimbursement from Blue Cross.

Refer to the medical policy for additional policy information.