NCQA Update: Credentialing is now required for locum tenens providers
October 2, 2025The National Committee for Quality Assurance (NCQA) now requires that accredited health plans credential locum tenens providers. This new policy, which went into effect July 1, 2025, marks a significant shift from the previous policy, which often exempted temporary providers from formal credentialing processes. The FAQs below explain how this new policy can affect your practice.
FAQs
What is a locum tenens provider?
A locum tenens provider is a licensed clinician who temporarily fills in for another provider during periods such as medical leave or vacation. Historically, these providers were authorized to treat patients under the supervising provider’s credentials, with claims submitted under the original provider’s name and TIN, using modifier Q6 to indicate locum status.
What’s changing?
The NCQA mandates now require all locum tenens providers to be credentialed if they practice under an accredited health plan. This policy change went into effect on July 1, 2025, in order to enhance oversight and ensure consistent quality of care, even during temporary coverage periods.
What does this mean for providers?
Credentialing required: Temporary providers must now undergo the same credentialing process as permanent staff.
Billing adjustments: Claims must still be submitted under the authorizing provider’s name, but credentialing status will be verified.
Scope of practice: Locum tenens must match the specialty of the provider they are covering (e.g., an oral and maxillofacial surgeon [OMFS] can only authorize another OMFS).
Licensure: Providers must be licensed in the state where services are rendered.
What do you do if your practice plans to use a locum tenens provider?
Begin the credentialing process early
Ensure documentation is in place to support coverage arrangements
If you have any questions or need additional guidance on billing and compliance, please contact your dental network manager.