Locum Tenens Guidance

TriWest has recently received inquiries regarding whether or not TRICARE recognizes Locum Tenens providers. According to Merriam-Webster’s Medical Dictionary, Locum Tenens is a medical practitioner who temporarily takes the place of another.

TRICARE manuals do not specifically address Locum Tenens providers at all because a provider – at a minimum – must be certified to be eligible for TRICARE reimbursement. Furthermore, if the provider expects to be reimbursed under a network agreement, that provider must be fully credentialed. This requirement applies to all providers regardless of whether the provider is going to be working with the group for 2 days or 2 years.

The following chart answers some basic questions regarding Locum Tenens coverage:

	Locum Tenens is Not TRICARE-Certified	Locum Tenens is TRICARE-Certified, not contracted	Locum Tenens is TRICARE-Certified and contracted
Credentialed	No	No	Yes
Can be paid by TRICARE	No	Yes	Yes
Can bill beneficiary	No	Same as any non-network provider; participating providers may collect cost-shares; non-participating providers may collect up to the legal amount* from the beneficiary (* CMAC + 15%)	Cost shares only

To summarize, a provider will not be reimbursed if they use Locum Tenens to provide services to TRICARE beneficiaries, unless the Locum Tenen is TRICARE-certified. If WPS can't certify the provider and processes the claim as a non-payable provider, the beneficiary would not be liable unless the beneficiary chose to have services rendered by a provider he/she knew was non-payable and agreed up front in writing to pay out of pocket. A Locum Tenens who has not been fully credentialed, but whose services are billed by a network provider, will be paid as non-network.

Providers using Locum Tenens should confirm the status of those Locum Tenens before services are provided to TRICARE beneficiaries to ensure that they can receive payment for services provided and to avoid any unnecessary out of pocket costs for beneficiaries. For further information, please refer to the TRICARE Operations Manual, Chapter 4, at www.tricare.mil.