Section · Administrative Rules of South Dakota · View on sdlegislature.gov ↗
A claim for private duty nursing and extended home health aide services provided in this chapter must be submitted on a form or in an electronic format that contains the following information: (1) The service recipient's full name; (2) The recipient's medical assistance identification number from the recipient's medical assistance identification card; (3) Third-party liability information required under chapter 67:16:26; (4) Date of service; (5) Place of service; (6) The provider's usual and customary charge. The provider may not subtract other third-party payments from this charge; (7) The applicable procedure codes for the covered services provided; (8) The applicable diagnosis codes; (9) The units of service furnished, if more than one; (10) The provider's name and National Provider Identification number; and (11) The prior authorization number issued by the department. A separate claim form must be used for each recipient.
Source: 18 SDR 209, effective June 23, 1992; 19 SDR 26, effective August 23, 1992; 19 SDR 128, effective March 11, 1993; 20 SDR 149, effective March 21, 1994; 21 SDR 183, effective April 30, 1995; 35 SDR 88, effective October 23, 2008; 42 SDR 51, effective October 13, 2015; 52 SDR 126, effective July 1, 2026.