Within the busy provider world, locum tenens or substitute physician(s) usually assume professional practices in the absence of a regular physician for reasons such as illness, pregnancy, vacation, continuing education or even filling in while permanent providers are recruited. Coverage ranges from rural solo physician practices to the country’s major health systems and managed care organizations. Locum tenens work is designed to fill these vacancies on an interim basis, although assignments can vary in length from a few days to many months. The solo physician, system or organization generally pays the locum tenens directly as an independent contractor rather than an employee.
As covered health care providers, a locum tenens is eligible to obtain a National Provider Identifier (NPI). However, the interim substitute physician may or may not be a contracted Blue Cross and Blue Shield of Texas (BCBSTX) provider. Therefore, BCBSTX may not have a record of their NPI and claims received from the locum tenen would be rejected once submitted for processing. In these situations, the contracted BCBSTX provider should submit the claims using his or her provider record IDs and Tax Identification Number with the Q6 modifier (services furnished by a locum tenens physician). The Q6 modifier should be populated in one of the four modifier areas in field 24D of the CMS-1500 form.
If you have any questions, you may contact our Provider Customer Service Department at 1-800-451-0287 to speak with a Customer Advocate for assistance.