On occasion, a provider may arrange for a Locum Tenens (substitute) provider to see patients if he/she is out of the office and unavailable to provide chiropractic services.

 

 HNS Policy 

 

Other than claims reporting services by a Locum Tenens (substitute) provider, all claims filed to HNS contracted payors must accurately reflect the name of the provider that actually rendered services.

 

If a Locum Tenens (substitute) provider is utilized, claims reporting services provided by the Locum Tenens provider may be submitted under the provider’s name that has contracted with the Locum Tenens provider, for all covered services provided, if all of the following requirements are met:

 

  • The substitute provider is either in practice for himself/herself, part of another group practice or works solely as a locum tenens or “substitute” provider. In other words, the “substitute” provider cannot be an employee of the regular provider or have either a partnership or associate relationship with the “regular” provider.

  • The regular provider is unavailable to provide the services on the dates that the “substitute” provider is used (i.e. out of the office).

  • The patient has arranged, or seeks to receive, services from the regular provider.

  • The substitute provider does not provide the services over a continuous period of time, longer than 60 days.

  • The healthcare record properly reflects the name of the provider that rendered each service.

  • The “regular” provider must maintain thorough and accurate records indicating the name and NPI number of the “substitute” provider, the dates the “substitute” provider provided services, and the names of all patients who received services by the “substitute” provider.  This information must be readily available to HNS and our contracted payors.

 

NOTE: A provider may have reciprocal arrangements with more than one provider.

 

If you have any questions regarding the appropriate employment of a Locum Tenens provider and/or associated billing requirements, please contact your HNS Service Representative for assistance.