Locum Tenens
Defines credentialing and reimbursement rules for Locum Tenens providers who temporarily render services to Anthem Blue Cross and Blue Shield Central Region members (Kentucky, Indiana, Ohio, Missouri, Wisconsin). Affects participating individual or group practices and locum providers.
No material clinical or coverage changes in this revision.
Credentialing rule for Locum Tenens Providers
Credentialing requirement for Locum Tenens Providers
Determines when a locum tenens provider must be credentialed.
ALL of the following
- If a Locum Tenens Provider renders services for less than six months: credentialing is not required.
- Provider Maintenance Form (PMF) must be completed with a notation 'Locum Tenens' and include NPI; locum will not be represented in member materials if non-credentialed.
- If a Locum Tenens Provider renders services for six months or more: they are no longer considered Locum Tenens and must be credentialed if they practice in a specialty and/or capacity that requires credentialing.
- Exception for Indiana: Network Management may, at its sole discretion, contract directly with Locum Tenens Providers for services to Covered Individuals in rural areas instead of credentialing.
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