For Providers

Medicaid Reimbursement and Billing

Medicaid Provider Enrollment Requirements by State
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The following information includes state-specific provider enrollment requirements for states where BCBS Plans offer Medicaid products. Please refer to the table below for state-specific Medicaid provider enrollment requirements if your claim has been denied and you have received notice from a BCBS Plan that the state where the member is enrolled in Medicaid requires that providers enroll in that state’s Medicaid program before the BCBS Plan can issue payment.

State BCBS Plan Out-of-State Enrollment Requirement Other State Medicaid Enrollment Accepted? Detail on Out-of-State Enrollment Requirement Language Link to Requirement Link to State Provider Page
California Anthem Blue Cross of California Not Required Not Applicable (Enrollment Not Required)

Requirements:

An out-of-state provider does not need to register in order to bill Anthem.

Reference to Requirements:


Provider Enrollment Regulations (See section titled, ‘Statutes, Regulations and Provider Bulletins’)

Link to Provider Page:

 

Medicaid Provider Enrollment

Delaware Highmark Blue Cross Blue Shield Delaware Not Required Not Applicable (Enrollment Not Required)

Requirements:

The website does not address out-of-state providers specifically and Delaware requirements are not well defined for the MCOs.

Highmark assumes that since it is not defined, the state does not require provider enrollment.

Reference to Requirements:

State Medicaid Provider Manual

Link to Provider Website:


http://www.dmap.state.de.us/information/disclosure/disclosure.html

Hawaii HMSA Not Required Not Applicable (Enrollment Not Required)

Requirements:

Out-of-state provider enrollment is not required.

Reference to Requirements:

No reference found.  

Link to Provider Page:


No Provider Enrollment page available.

Illinois Blue Cross and Blue Shield of Illinois Information not available.
   
Information not available.
   

Information not available.
Please contact
your local
BCBS Plan
for information.

Reference to State Medicaid Page:

http://www.illinois.gov/hfs/Pages/default.aspx

Link to Provider Page:


http://www.illinois.gov/hfs/MedicalProviders/Pages/default.aspx

Indiana Anthem Blue Cross and Blue Shield Indiana Yes No

Requirements:

Enrollment is required for any provider submitting a claim for the state of Indiana Medicaid Program.

If the provider is not registered with the state of Indiana, the encounter will reject.

References to Requirements:


Manual for Provider Enrollment, Eligibility and Responsibilities

Indiana State Medicaid Rules (Article 5 Medicaid Services)

Link to Provider Page:

 

Indiana Medicaid Provider Website
   

Kentucky Anthem Blue Cross and Blue Shield Kentucky Yes

Yes, but also must enroll with Kentucky

(Out-of-state Enrollment is not a replacement)

Requirements:

Providers must have a Kentucky Medicaid ID in order to be paid.  

Reference to Requirements:

http://www.chfs.ky.gov/dms

Link to Provider Page:


http://www.chfs.ky.gov/dms/provEnr/

Michigan Blue Cross Blue Shield of Michigan Not Required Not Applicable (Enrollment Not Required)

Requirements:

Any providers who submit claims for BCBS Michigan members would not be required to enroll since BCBS MI is an MCO.

Reference to Requirements:

MI Provider Enrollment Website

Link to Provider Page:


MI Provider Website

Minnesota Blue Cross and Blue Shield of Minnesota Not Required Not Applicable (Enrollment Not Required)

Requirement:

Providers who submit claims to Minnesota Medicaid Managed Care Organization (including as BCBS of MN) are not required to enroll with Minnesota DHS.

Reference to Requirements:

MN Provider Enrollment Website

Link to Provider Page:


MHCP Enrolled Providers Website

New Jersey Horizon Blue Cross Blue Shield of New Jersey Not Required Not Applicable (Enrollment Not Required)

Requirements:

New Jersey does not require providers to enroll/register with Medicaid prior to rendering services or being reimbursed by Medicaid HMOs (such as Horizon).

Reference to Requirements:

No reference found.

Link to Provider Page:


No Provider Enrollment page available.

New Mexico Blue Cross and Blue Shield of New Mexico Information not available. Information not available.

Information not available.
Please contact
your local
BCBS Plan
for information.

Reference to State Medicaid Page:

http://www.hsd.state.nm.us/mad/index.html

Link to Provider Page:


http://www.hsd.state.nm.us/providers/Default.aspx

New York

Healthnow


Excellus Blue Cross Blue Shield

Not Required Not Applicable (Enrollment Not Required)

Requirements:

Enrollment in New York State Medicaid is not required for out-of-state professional or institutional providers to bill an MCO in New York State.

Reference to Requirements:

Link to provider Manual

Link to Provider Page:


eMedNY Provider Website

Pennsylvania

Independence Blue Cross


Highmark

Yes

Yes, but also must enroll with PA


(Out-of-state Enrollment is not a replacement)

Requirements:

Out-of-State providers must enroll in Pennsylvania’s Medicaid program, but must be enrolled first in their home state.

Out-of-state practitioners must be licensed and currently registered by the appropriate agency in their state and they must provide documentation that they participate in that state's Medicaid program.

The Plan’s Prior Authorization line operators will be trained to insist that out of area providers enroll.

Reference to Requirements:

Pennsylvania Enrollment Information  

Link to Provider Page:


Pennsylvania Provider Website

Puerto Rico Triple S Information not available.   Information not available.  

Information not available.
Please contact
your local
BCBS Plan
for information.

Reference to Puerto Rico Medicaid Page:

https://www.medicaid.pr.gov/(X(1)S(gn2b34krv34s01lsnvq2y4i2))/default.aspx?AspxAutoDetectCookieSupport=1

Link to Provider Page:


Links not available.  

South Carolina Blue Cross and Blue Shield of South Carolina Yes – for services other than emergency that have prior authorization. No

Requirements:

For services other than emergency that require prior authorization, the out-of-state provider must confirm, in writing, that he or she will enroll in the South Carolina Medicaid program and will accept Medicaid reimbursement as payment in full.

Reference to Requirements:

Provider Enrollment and Screening Requirements

Link to Provider Page:


Healthy Connections Medicaid Provider Information  

Tennessee Blue Cross Blue Shield of Tennessee Yes No

Requirements:

New TennCare/ Medicaid providers need to register. 

Reference to Requirements:

Provider Registration  

Link to Provider Page:


TennCare Providers

Texas Blue Cross and Blue Shield of Texas Information not available. Information not available.

Information not available.
Please contact
your local
BCBS Plan
for information.

Reference to State Medicaid Page:

http://www.hhsc.state.tx.us/

Link to Provider Page:


http://www.hhsc.state.tx.us/Programs/index.shtml

Virginia Anthem Blue Cross and Blue Shield Virginia Yes

Yes


Enrollment in state Medicaid Program where provider practices is also required.

Requirements:

Billing, Rendering, and Attending Providers need to be registered on the master file with the state.

For physicians that operate out-of-state (more than 50 miles from the VA border) you will also need to attest to enrollment in your resident state Medicaid program.

Reference to Requirements:

Provider Enrollment Tutorial

Link to Provider Page:


DMAS Provider Services DMAS Provider Resources

Wisconsin Anthem Blue Cross and Blue Shield Wisconsin Not Required Not Applicable (Enrollment Not Required)

Requirements:

Out-of-state providers who do not meet the requirements for border state enrollment may be reimbursed for non-emergency services provided to a Wisconsin medical assistance recipient through a prior authorization, under Wisconsin state law DHS 107.04.

Reference to Requirements:

Wisconsin State Legislature Rule for Out-of-State Providers  

Link to Provider Page:


Forward Health Provider Links