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Section 4.14 of the Preferred Medical Doctor (PMD) Agreement states in part, “Physician shall not allow non-Preferred physicians or other allied health professionals to bill the Corporation for services using the Physician’s Provider Number.” Section 4.17 states in part, “Preferred general practice, family practice, internal medicine, geriatrics and OB/GYN physicians will exercise reasonable efforts to arrange for 24 hour, seven day per week call coverage.”
As a general policy, the physician rendering the service should bill with his or her own provider number. In the circumstance of temporary coverage/locum tenens arrangements the physician should exercise reasonable efforts to ensure that the covering physician is PMD.
In the event that a non-PMD physician must be used, the PMD physician may bill for the non-PMD physician under his/her provider number if the services are provided on a temporary/non-routine basis such as locum tenens. If the locum tenens or covering physician replaces the physician for more than two weeks, or on a regular, ongoing basis (for example, every weekend), the covering physician should get a provider number through Blue Cross and bill under his/her own provider number. The medical records should reflect the signature style, “Doctor X covering for Doctor Y,” as a matter of prudent documentation practices.
Below is a list of modifiers that may be placed on the claim following the procedure code to signify involvement in patient care by someone other than the "regular" physician. Although we do not require these modifiers be placed on the claim, any information that can help communicate involvement by another provider is considered helpful for processing.
Q5 - Service Furnished By Substitute Physician Reciprocal
Q6 - Service Furnished By A Locum Tenens Physician