As of March 1, 2016
Purpose:
The purpose of this document is to provide information on state specific provider enrollment requirements for states where BCBS Plans offer Medicaid products. This document will be updated as BCBS Medicaid Plans provide updated requirement information.
Background:
State Medicaid agencies contract with Blue Cross and Blue Shield Plans as Managed Care Organizations (MCOs) to provide comprehensive Medicaid benefits on a risk basis. Federal regulations guide these relationships, but the eligible population, covered benefits and specific rules regarding each state’s Medicaid program may differ from state to state. Many state Medicaid programs require providers to enroll as Medicaid provides with the state Medicaid agency before payment can be issued. In some cases, state Medicaid programs requiring provider enrollment will accept a provider’s Medicaid enrollment in the state where the provider practices. Information in this document was confirmed by the BCBS Plans that have Medicaid business in the states listed.
Provider Instructions:
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 their 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) | An out-of-state provider does not need to register in order to bill Anthem. |
Provider Enrollment Regulations (See section titled, ‘Statutes, Regulations and Provider Bulletins’) |
Medicaid Provider Enrollment |
| Delaware | Highmark Blue Cross Blue Shield Delaware | Not Required | Not Applicable (Enrollment Not Required) |
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. |
State Medicaid Provider Manual | http://www.dmap.state.de.us/information/disclosure/disclosure.html |
| Hawaii | HMSA | Not Required | Not Applicable (Enrollment Not Required) | Out-of-state provider enrollment is not required. | No reference found. | No Provider Enrollment page available. |
| Illinois | Blue Cross and Blue Shield of Illinois | Yes |
Yes, but also must enroll with Illiniois. (Out-of-state Enrollment is not a replacement) |
Enrollment is required for any provider submitting a claim for the state of Illinois Medicaid Program. | IL Provider enrollment website | http://www.illinois.gov/hfs/MedicalProviders/Pages/default.aspx |
| Indiana | Anthem Blue Cross and Blue Shield Indiana | Yes | No |
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. |
Indiana Medicaid for Providers | 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) |
Providers must have a Kentucky Medicaid ID in order to be paid. | https://chfs.ky.gov/agencies/dms/dpi/pe/Pages/default.aspx | http://www.chfs.ky.gov/dms/provEnr/ |
| Michigan | Blue Cross Blue Shield of Michigan | Not Required | Not Applicable (Enrollment Not Required) | Any providers who submit claims for BCBS Michigan members would not be required to enroll since BCBS MI is an MCO. | MI Provider Enrollment Website | MI Provider Website |
| Minnesota | Blue Cross and Blue Shield of Minnesota | Not Required | Not Applicable (Enrollment Not Required) | Providers who submit claims to Minnesota Medicaid Managed Care Organization (including as BCBS of MN) are not required to enroll with Minnesota DHS. | MN Provider Enrollment Website | MHCP Enrolled Providers Website |
| New Jersey | Horizon Blue Cross and Blue Shield | Not Required | Not Applicable (Enrollment Not Required) | New Jersey does not require providers to enroll/register with Medicaid prior to rendering services or being reimbursed by Medicaid HMOs (such as Horizon). | No reference found. | No Provider Enrollment page available. |
| New Mexico | Blue Cross and Blue Shield of New Mexico | Yes |
Yes, but also must enroll with New Mexico. (Out-of-state Enrollment is not a replacement) |
Enrollment is required for any provider submitting a claim for the state of New Mexico Medicaid Program. | NM Provider Enrollment Website | New Mexico Medicaid Provider Portal |
| New York |
Healthnow Excellus Blue Cross Blue Shield |
Not Required | Not Applicable (Enrollment Not Required) | 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. | Link to Provider Manual | eMedNY Provider Website |
| Pennsylvania |
Independence Blue Cross Highmark |
Yes |
Yes, but also must enroll with PA (Out-of-state Enrollment is not a replacement) |
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. |
Pennsylvania Enrollment Information | 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 | Links not available. |
| South Carolina | Blue Cross and Blue Shield of South Carolina | Yes – for services other than emergency that have prior authorization. | No | 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. | Provider Enrollment and Screening Requirements | Healthy Connections Medicaid Provider Information |
| Tennessee | Blue Cross Blue Shield of Tennessee | Yes | No | New TennCare/ Medicaid providers need to register. | Provider Registration | TennCare Providers |
| Texas | Blue Cross and Blue Shield of Texas | Yes |
Yes, but also must enroll with TX STAR Program. (Out-of-state Enrollment is not a replacement) |
Enrollment is required for any provider submitting a claim for the state of Texas Medicaid Program | Texas Medicaid Provider Enrollment | Texas HHSC |
| Virginia | Anthem Blue Cross and Blue Shield Virginia | Yes |
Yes Enrollment in state Medicaid Program where provider practices is also required. |
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. |
Provider Enrollment Tutorial | |
| Wisconsin | Anthem Blue Cross and Blue Shield Wisconsin | Not Required | Not Applicable (Enrollment Not Required) | 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. | Wisconsin State Legislature Rule for Out-of-State Providers | Forward Health Provider Links |
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform.
|