Confused when billing a locum tenens dentist? We answer your top 5 questions

It happens: You’re going out of town, or you’re understaffed and need a “substitute” dentist to keep your practice going — aka, a locum tenens dentist. That’s simple enough in theory, but there are so many questions: Do you really need one? Where do you find one? And where do you put a locum tenens dentist on the dental insurance claim? We answer these top questions and more to help you get reimbursed faster.

The American Dental Association (ADA) defines a locum tenens as:

“A person who temporarily fulfills the duties of another. For example, a locum tenens dentist is a dentist who works in the place of the regular dentist when that dentist is absent, or when a practice is short-staffed.”

Finding a locum tenens dentist is relatively simple. The challenge is knowing how to record them on a dental insurance claim, and how that might affect your billing workflow.

Fortunately, our DCS Knowledge Network is a pool of 100+ experts who have a deep understanding of how insurance billing works, including exceptions like a substitute dentist.

This article clears up the confusion by answering 5 top questions about locum tenens dentists.

Key takeaways on billing for a locum tenens dentist: 

• There are companies who’ll help you find a locum tenens dentist — don’t worry!
• Do not list your usual dentist as the treating dentist when using a locum tenens dentist
• When in doubt, contact your in-network provider for direction on billing for a locum tenens dentist

Question #1. “When do I need a locum tenens dentist?”

There are a dozen scenarios where a substitute dentist is needed, and the needs of every dental practice are different. Whether you’ll need one is based on your in-network insurance carriers, your rate of production, and if you have more than one dentist at your practice.

The most common scenarios are a dentist going on vacation, dealing with an illness, or taking disability leave for up to 12 months. Keep in mind that locum tenens dentists are only meant to be a temporary replacement, and a year is typically the maximum term.

Here are a few more specific scenarios where you may want to use a locum tenens dentist to maintain patient care and productivity for your dental business:

• The dentist is taking an extended vacation
• The dentist is attending an industry conference
• The dentist is deceased  
• The dentist is nearing retirement and dialing back their involvement  
• The dentist is out of the office for continuing education (CE) or other training
• The dentist has a medical disability (including maternity leave) and will be out of the practice while they recover

Be sure to inform the insurance companies you’re in-network with that you’ll be using a locum tenens dentist, along with the start and end dates for your dentist’s absence. 

Question #2. “How do I find a locum tenens dentist?”

You can either track down a locum tenens yourself, or use a company to find them for you. There are placement agencies especially for recruiting, vetting, and assigning the right locum tenens dentist for your practice. You can even have the same locum tenens dentist return to your practice as needed.

For example, the Barton Associates placement agency matches locum tenens dentists, and they also:

• Supply malpractice insurance and background checks 
• Confirm their state licensure(s) and look for any board actions, and
• Provide all the documentation required for credentialing or temporary credentialing.

Some wise advice from the ADA:

“There are companies that specialize in providing dentists for temporary assignments. When researching these companies, it is recommended you choose a reputable firm, and asking for references is also a good idea. You may also want to get a referral from a local dental office that has previously used a locum tenens dentist.”

There are also dentists who represent themselves as a locum tenens. When you work with a locum tenens dentist directly — that is, without a third party, agency, or outsourced company — you may be asked to pay your locum tenens dentist an hourly or daily rate. 

As they would be an independent contractor, you will likely need to issue a 1099 the following January, similar to the W-2s for your employees. Be sure to check with your accountant for details.

Question #3. “Does the locum tenens dentist need to be credentialed with my in-network insurance plans?” 

If you want the claims to process as in-network, the answer is yes! Your locum tenens dentist must be credentialed with your in-network insurance plans, as this affects how much your patient will pay out-of-pocket. 

Oftentimes, you can call your in-network provider’s relations department to request a locum tenens be added as in-network at your practice’s address. The provider may ask you to complete a temporary application to avoid the full credentialing process.

Read more: Top 5 mistakes dentists make in the dental credentialing process

That’s good news, as we all know that credentialing can take months! The process can be expedited for medical emergencies or sudden vacancies, but vacations don’t usually qualify for speeding up the provider’s addition of a locum tenens dentist. 

More good news: the process may be quicker if your selected locum tenens dentist has been at your location before. 

However, a locum tenens who is in-network at one practice or location isn’t automatically in-network with your practice or your other locations. Call your provider to confirm.

Question #4. “Why is it crucial to inform insurance companies I’ll be using a locum tenens dentist?”

We always recommend informing your insurance company when you plan to use a locum tenens dentist. With revenue on the line, it’s worth your time to confirm what’s needed for your locum tenens dentist insurance claims to be processed as in-network.

Be sure to document the name of your insurance provider’s representative, as well as the date and time, and also obtain a reference number for the conversation. Keep that information in your locum tenens file in case you need to prove your due diligence.

This clarification with your provider is extremely important, because if the treatment isn’t attributed properly, the insurance carrier may not cover the treatment provided by the locum tenens as the treating dentist. 

This guarantees a higher bill for your patient, which will upset them if it’s unexpected. Some companies will send the insurance payment directly to the patient if the treatment is out-of-network, which will probably add to your patient’s dissatisfaction.

So yes! When using a locum tenens dentist, inform your in-network providers and also your patients, in case their out-of-pocket costs are affected.

Question #5. “How does a locum tenens dentist affect my claim submissions?”

Fortunately, only one area of your claim form will need to be completed differently. It’s simple and straightforward, and it’s critical that you get it right. Getting it wrong will lead to a claim denial, and maybe even accusations of dental insurance fraud. 

To start, it’s essential that your team use the most up-to-date ADA claim form. Submitting an outdated form will result in a rapid claim rejection by insurers. 

At the bottom of the ADA form, you’ll see boxes for Billing Dentist or Dental Entity and Treating Dentist and Treatment Location Information as well as a space for a locum tenens dentist.

We highly recommend that your team uses the proper 2024 ADA form. 

Sample 2024 claim form from ADA website. 

The Treating Dentist box — circled — is where you’ll include information about your locum tenens dentist. Remember, they are the Treating Dentist, not the Billing Dentist.

This is where mistakes happen: This part of the claim form is often pre-populated with your in-house dentist’s information. You’ll need to manually replace it with your locum tenens dentist’s information, including:

• The locum tenens’ NPI number
• Their license number, and
• The location of the dental practice where they treated the patient.

Related: Denied insurance claims: 3 ways they damage your dental business and 1 solution

Bill confidently with locum tenens and collect all the revenue you deserve

To recap, we answered these 5 top questions about billing a locum tenens dentist: 

1. “When do I need a locum tenens dentist?”
2. “How do I find a locum tenens dentist?”
3. “Does the locum tenens dentist need to be credentialed with my in-network insurance plans?” 
4. “Why is it crucial to inform insurance companies I’ll be using a locum tenens dentist?”
5. “How does a locum tenens dentist affect my claim submissions?”

It’s important to bill a locum tenens dentist correctly on your insurance claims to ensure a successful claim submission. You don’t want interruptions to your cash flow every time a dentist is out of the office. 

And when you work with DCS, you can always turn to our experts in the DCS Knowledge Network with your insurance claim questions. And remember: our insurance billing solutions are just one part of our end-to-end revenue cycle management suite of services. 

Bill confidently and collect what you deserve — even with a substitute dentist: Book a free 30-minute consultation today.