Medicaid Provider Enrollment Requirements by State
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: |
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: |
Link to Provider Website: https://medicaid.dhss.delaware.gov/provider/Home/tabid/135/Default.aspx |
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 Blue Shield of Illinois | Information not available. | Information not available. |
Information not available. |
Reference to State Medicaid Page: |
Link to Provider Page: http://www.illinois.gov/hfs/MedicalProviders/Pages/default.aspx |
Indiana | Anthem Blue Cross 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: |
Kentucky | Anthem Blue Cross 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: |
Link to Provider Page: |
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: |
Link to Provider Page: |
Minnesota | Blue Cross 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: |
Link to Provider Page: |
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 Blue Shield of New Mexico | Information not available. | Information not available. |
Information not available. |
Reference to State Medicaid Page: |
Link to Provider Page: |
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 Page: |
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: |
Link to Provider Page: |
Puerto Rico | Triple S | Information not available. | Information not available. |
Information not available. |
Reference to Puerto Rico Medicaid Page: |
Link to Provider Page: Links not available. |
South Carolina | Blue Cross 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: |
Link to Provider Page: |
Tennessee | Blue Cross Blue Shield of Tennessee | Yes | No |
Requirements: New TennCare/ Medicaid providers need to register. |
Reference to Requirements: |
Link to Provider Page: |
Texas | Blue Cross Blue Shield of Texas | Information not available. | Information not available. |
Information not available. |
Reference to State Medicaid Page: |
Link to Provider Page: https://hhs.texas.gov/doing-business-hhs/medicaid-provider-enrollment |
Virginia | Anthem Blue Cross 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: |
Link to Provider Page: |
Wisconsin | Anthem Blue Cross Blue Shield Wisconsin | Not Required | Not Applicable (Enrollment Not Required) |
Requirements: Out-of-state providers who do not meet the requirements forborder 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: |
Link to Provider Page: |