Locum Billing in Alberta
— Complete Guide for Locum Physicians (2026)
Locum work offers Alberta family physicians flexibility and competitive income, but billing under your own provider number introduces unique challenges that cost many locums 20-30% of potential revenue. Understanding the 2026 SOMB rules—where a brief visit bills at $37.15 and complex encounters reach $72.85—is critical to ensuring you're paid fairly for every patient you see. This guide breaks down exactly how locum billing works in Alberta, which codes apply, and how to avoid the documentation mistakes that trigger claim denials.
How Locum Billing Works Under SOMB 2026
When you work as a locum in Alberta, you bill under your own AHCIP provider number, not the host physician's number. This fundamental rule applies to nearly all locum arrangements and means every claim you submit identifies you as the responsible physician, not the practice owner. The 2026 SOMB maintains this requirement across all visit codes, including the bread-and-butter 03.03A brief visit at $37.15 and the higher-value 03.03C complex visit at $72.85.
The practical implication is that your billing patterns, claim history, and audit risk profile build under your own provider number throughout your locum assignments. This creates both opportunity and responsibility: you have full control over code selection and can bill the same range of services as permanent physicians, but you're also personally accountable for documentation quality and billing compliance. Many locums mistakenly believe they're limited to basic visit codes or that modifiers don't apply to them—this leaves significant revenue on the table.
Understanding that locum status doesn't change the SOMB rules is critical. You apply the exact same eligibility criteria, complexity thresholds, and documentation standards as the host physician would. The only difference is whose provider number appears on the claim. This means you can—and should—bill chronic disease management add-ons like 03.05W at $27.39 per condition when you're managing diabetes, hypertension, or COPD during locum encounters, just as you would in your own practice.
Billing Codes That Apply
Locum physician bills under their own AHCIP provider number for patients of the host practice.
Must use own provider number. Cannot bill under host physician's number (except in specific ARP arrangements).
Standard visit documentation plus locum physician identifier.
Same eligibility as regular 03.03C. Locum physicians apply all standard SOMB rules.
All standard 03.03C limits apply. Host physician arrangements do not change billing rules.
Full complexity documentation required.
Locum physicians can bill 03.05W for chronic conditions managed, exactly as permanent physicians do.
Up to 3× per encounter. Requires primary visit code.
Chronic conditions managed, decisions made.
Common Documentation Mistakes That Trigger Claim Denials
Alberta Health auditors need to clearly see who provided the service. Always include your name and 'locum for Dr. [Host Name]' in your encounter note header. Without this identifier, claims may be flagged as potential duplicate billing if the host physician has other encounters the same day, or auditors may question whether you actually provided the service personally.
The $72.85 complex visit code requires explicit documentation of what made the encounter complex—multiple problems addressed, detailed history elements, comprehensive examination findings, or complex decision-making. Simply writing 'complex visit' or having a long note isn't sufficient. Document specifically: '3 active problems addressed today: uncontrolled diabetes with medication adjustment, new-onset chest pain requiring ECG and cardiology referral, and chronic back pain management review.'
To bill the $27.39 chronic disease add-on, your note must show active management of the chronic condition during this encounter—not just that the patient has the condition. Document what you reviewed (recent labs, symptoms, compliance), what decisions you made (medication changes, referrals, monitoring plans), and any patient education provided. 'Diabetes stable, continue current meds' doesn't support 03.05W; 'Reviewed A1C 7.8%, increased metformin to 1000mg BID, discussed dietary modifications, recheck labs in 3 months' does.
Unless you're in a specific Alternative Relationship Plan arrangement that explicitly permits it, you must bill under your own AHCIP provider number. Billing under the host's number is considered improper billing and creates significant compliance risk for both you and the host physician. Always confirm your locum arrangement specifies billing under your own number, and configure your EMR or billing system accordingly before you see your first patient.
Many locums unnecessarily restrict themselves to basic visit codes, believing their temporary status limits billing options. This is false. As a locum, you have access to the full SOMB schedule exactly as permanent physicians do—you can bill complex visits, chronic disease management, procedures, and appropriate modifiers based on what you actually do clinically. The only limitation is that you must personally perform and document the service; you're not inheriting the host physician's patient relationships or care continuity for billing purposes.
Real Example: Maximum Revenue Scenario
65-year-old established patient of host practice presents for medication renewal. Patient has type 2 diabetes, hypertension, and hyperlipidemia. You review recent lab work showing suboptimal diabetes control (A1C 8.2%), adjust insulin dosing, review home glucose log, increase amlodipine for elevated BP readings, discuss statin adherence, and arrange follow-up labs.
Frequently Asked Questions
Do I need to be rostered to the patients I see as a locum to bill chronic disease management codes like 03.05W?
No. Rostering is not a requirement for billing 03.05W ($27.39 per condition) in Alberta. The SOMB eligibility criteria require only that you actively manage the chronic condition during the encounter—adjusting treatment, reviewing monitoring data, providing disease-specific counseling, or modifying care plans. As a locum, you bill under your own provider number for services you personally provide, and if you're genuinely managing chronic conditions during those encounters, 03.05W is appropriate regardless of rostering status or continuity relationship.
Can I bill a complex visit (03.03C at $72.85) for a patient I'm seeing for the first time as a locum, or does complexity require prior knowledge of the patient?
Absolutely—you can and should bill 03.03C when clinically appropriate, even for patients you've never seen before. Complexity is determined by the nature of the encounter itself: multiple problems addressed, detailed history required, comprehensive examination, or complex medical decision-making. Seeing a patient as a locum doesn't reduce the clinical complexity of managing their acute exacerbation of COPD with three comorbidities. Document what made it complex (the problems addressed, the decision-making required, the examination performed), and bill accordingly using your own provider number.
What happens if the host physician already billed for seeing the same patient earlier the same day—can I still bill under my provider number for a separate encounter?
Yes, if you provided a distinct, separate service. Each physician's services bill under their own provider number, so if the patient saw the host physician in the morning and returns with a new problem in the afternoon when you're covering, that's a separate billable encounter under your number. However, if you're simply completing documentation or follow-up from an encounter the host physician already started and billed, you cannot bill separately. The key is whether you provided a distinct clinical service with its own assessment and plan—document clearly that this was a separate encounter with a new presenting complaint or clinical need.
If I'm doing a two-week locum, should I bill 03.03A ($37.15) for quick follow-ups even if I saw the patient two days ago, or does that count as duplicate billing?
You can bill for each distinct clinical encounter you provide, regardless of how recently you last saw the patient, as long as there's a legitimate clinical reason for the visit. A patient returning two days later with a new concern, worsening symptoms, or planned follow-up to reassess response to treatment is a separate billable service. Use the visit code (03.03A or 03.03C) that matches the complexity of what you actually did during that encounter. Duplicate billing concerns arise when you bill twice for the same service or bill for services not actually rendered—not from seeing the same patient multiple times for legitimate clinical reasons during your locum period.
Do locums get paid less per visit than permanent physicians in Alberta, or are the SOMB fees the same regardless of employment status?
The SOMB fees are identical regardless of whether you're a locum, permanent physician, or practice owner. A brief visit (03.03A) pays $37.15 and a complex visit (03.03C) pays $72.85 for every physician billing Alberta Health. What differs is how you arrange payment with the host practice—some locum arrangements involve paying the host a daily rate or percentage for overhead and use of their patient panel, but that's a private contractual arrangement separate from what Alberta Health pays for the claims. Your claims to Alberta Health should reflect exactly what you did clinically, using your own provider number, at standard SOMB rates.
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