The Interstate Medical Licensure Compact (IMLC) is an expedited pathway for physicians to obtain licenses in multiple states. As of 2025, 42 states plus the District of Columbia and Guam participate in the compact. More than 150,000 physician licenses have been issued through the IMLC since its creation.

For practices expanding into multi-state telehealth or operating across state lines, the IMLC reduces the licensing burden significantly. What it does not do is solve the billing side. A license in a new state does not automatically mean the provider is enrolled with payers, credentialed with plans, or ready to submit claims in that state.

This article covers what the IMLC does for licensing, what it does not do for billing, and what the practice needs to handle separately. It is a billing operations guide, not legal advice.

What the IMLC does

The IMLC provides a streamlined application process for physicians who want to obtain licenses in multiple compact states. The physician applies through their state of principal license, and the compact facilitates the application to other participating states.

Key facts about what the compact provides:

  • Expedited processing. The IMLC application moves faster than applying to each state individually. Physicians receive an average of four licenses through the compact.
  • Standardized eligibility. The compact has uniform eligibility requirements, including holding an unrestricted license in the state of principal license.
  • Individual state licenses. Each participating state still issues its own license. The IMLC is not a single multi-state license. It is a faster path to obtaining separate state licenses.

For practices that need providers licensed in multiple states for telehealth, the IMLC removes weeks or months of application processing time.

What the IMLC does not do for billing

This is where practices get caught. The license is step one. The billing infrastructure for each state is a separate set of steps that the compact does not address.

Provider enrollment

Having a license in a state does not mean the provider is enrolled with Medicare, Medicaid, or commercial payers in that state. Each payer requires its own enrollment application, and enrollment timelines vary from days to months depending on the payer and the state.

If the provider sees a patient in a new state before payer enrollment is complete, the claim will likely be denied. Retroactive enrollment may not be available for all payers. The practice should start payer enrollment as soon as the state license is issued, not after the first patient is scheduled.

Credentialing with commercial plans

Commercial plans in each state have their own credentialing processes. Being credentialed with Blue Cross in one state does not mean the provider is credentialed with Blue Cross in another state, even if it is the same national carrier. Each state’s plan may require a separate credentialing application.

Medicaid enrollment per state

Each state’s Medicaid program is independent. A provider enrolled in one state’s Medicaid is not enrolled in another’s. If the practice sees Medicaid patients across state lines, each state’s Medicaid program requires its own enrollment, and each state’s managed care organizations require their own credentialing.

Payer-specific telehealth rules

Telehealth coverage and reimbursement rules vary by state and by payer. Some states have telehealth parity laws. Others do not. Medicare’s telehealth rules have their own geographic and location requirements. Commercial plans may have different telehealth policies in different states.

The IMLC gives the provider the license to practice. It does not tell the practice how telehealth claims should be coded, submitted, or reimbursed in each state.

The billing gap between licensing and revenue

The typical sequence for a practice expanding to a new state:

  1. Apply for the state license (IMLC expedites this step).
  2. Receive the state license.
  3. Apply for Medicare enrollment in that state.
  4. Apply for Medicaid enrollment if applicable.
  5. Apply for credentialing with commercial plans.
  6. Wait for enrollment and credentialing to be approved.
  7. Begin seeing patients and billing claims.

Steps 3 through 6 are where the delay lives. The IMLC accelerates step 1, but the billing infrastructure in steps 3-6 takes its own time. A practice that schedules patients in a new state as soon as the license arrives, without confirming payer enrollment, will see claims denied.

What the practice should track per state

For each state where the provider holds a license:

  • License status. Current, renewal date, CME requirements.
  • Medicare enrollment. Application status, effective date, PECOS enrollment.
  • Medicaid enrollment. Application status, MCO credentialing status, effective date.
  • Commercial plan credentialing. Application status for each major plan in that state.
  • Telehealth rules. State parity law status, payer-specific telehealth policies, place-of-service coding requirements.
  • Malpractice coverage. Whether the current policy covers practice in that state.

If the practice cannot answer those questions for each state, it has a licensing solution but not a billing solution.

Common mistakes

  • Scheduling patients in a new state before payer enrollment is confirmed.
  • Assuming that a national carrier’s credentialing in one state transfers to another state.
  • Not tracking license renewal dates across multiple states (the IMLC facilitates initial licensing, but renewals follow each state’s own timeline).
  • Billing telehealth claims without confirming the state’s specific coding and reimbursement rules.
  • Assuming Medicaid enrollment in one state provides access to another state’s Medicaid program.

For the broader guide to cross-state telehealth billing, see Cross-State Telehealth Licensing and How It Affects Your Billing.

How Neobill can help

Neobill works with practices expanding across state lines through the IMLC or other licensing pathways. The free audit reviews provider enrollment status, payer credentialing, telehealth claim patterns, and the billing gaps between licensing and revenue collection across multiple states.