Locum tenens, incident-to not acceptable alternatives to credentialing M.D.s

Why This Topic Matters

Credentialing delays can affect when a provider can legitimately bill a plan and can create compliance risk if practices rely on informal work-arounds. Understanding payer expectations helps practices reduce claim denials and avoid enrollment-related problems.

Article Sections

1. Question and answer on billing during pending credentialing

   The article opens with a billing question about a provider who is not yet credentialed and whether another physician’s billing information can be used in the interim. It frames the issue in terms of payer enrollment and physician billing relationships.

2. Why common work-arounds are risky

   This section summarizes expert commentary on incident-to billing, locum tenens, and other temporary billing approaches. It discusses why these arrangements may not be accepted by many payers and why they can create compliance concerns.

3. Credentialing quickly and correctly

   The article shifts to general credentialing best practices and administrative preparation for new providers. It emphasizes completing plan enrollment and related administrative steps before the provider begins work.

4. Find out what you need first

   This section covers how prior practice relationships and payer history can affect whether a physician is already credentialed or only needs contract linkage. It also notes that requirements can vary by payer and product line.

5. Ask payers about plan products

   The article explains that credentialing status may differ across a payer’s various plan types. It encourages practices to verify whether prior approval applies broadly or only to specific products.

6. Have a checklist

   This section addresses preparing documentation before contacting a payer for credentialing. It highlights the value of keeping credentialing records organized and complete.

7. Follow up frequently

   The final section focuses on monitoring the credentialing process after submission. It advises regular follow-up so practices can confirm the effective date and understand when billing can begin.