VSP requires its network providers to adhere to the following when utilizing a locum tenens (fill-in) doctor:

1. When using a fill-in doctor, such doctor shall be a VSP credentialed doctor in good standing.
2. If unable to arrange for a VSP credentialed doctor to fill-in the following applies:

• If the fill-in doctor(s) is to fill-in for a period of 10 days or less in a calendar year, VSP does not need to be notified and the use of a non-VSP credentialed provider shall be permitted.
• If the fill-in doctor(s) is to fill-in for a period of 11 days but not more than 60 days in a calendar year, VSP reserves the right to either approve or deny the fill-in doctor(s). The network provider shall contact VSP at least 10 calendar days in advance of a planned absence with the fill-in doctor’s name, degree, license number and NPI number. VSP will verify the following:

• All active states License
• Current individual doctor malpractice insurance coverage
• Malpractice claims history and/or sanctions
• Medicare /Medicaid sanctions via NPDB, OIG and SAM
• State Medicaid enrollment including State Agency suspension, exclusions and terminations list, if applicable
• Query the Master Death and NPPES
• Office of Foreign Assets (OFAC)
• CMS Preclusion List

VSP will notify network doctor of its decision and if approved by VSP, doctor(s) may fill-in for the network provider.

Should an emergency situation arise requiring an immediate and unplanned absence of 11-60 days in total, the network provider, or his or her staff, shall contact VSP as soon as the need for the immediate and unplanned absence arises, to provide the name, degree, license number and NPI number of the fill-in doctor(s). Network provider shall also provide VSP with information related to the emergency situation. The fill-in doctor(s) may be used for up to 10 days in total while the fill-in doctor’s verifications are obtained.

In no event shall a doctor or multiple doctors provide services on behalf of the same VSP network provider to VSP patients in the locum tenens capacity for more than 60 days in a calendar year unless otherwise specified by State regulation.

Submitting a Claim for Locum Tenens or Fill-in Providers

If you’re away for up to 60 days in a calendar year and use a Locum Tenens or fill in provider, you can submit a claim using eClaim or paper:

Submit the claim under your NPI and Tax ID number

Include the Locum Tenens or fill in provider’s NPI or SSN in box 19 “Reserved for Local Use” and a modifier for each line as follows:

Modifier Q5 – The covering physician must be a permanent part of the existing office practice, and is not hired from the outside, or operating under a different tax ID number, or billing for services provided under a ‘group practice’ tax ID number.

Modifier Q6 – The Locum Tenens provider is brought in or hired from outside the existing office practice.