Section · Administrative Rules of South Dakota · View on sdlegislature.gov ↗
A claim for services provided under this chapter must be submitted on a form available from the department or the claim may be electronically transmitted through a system approved by the department. The claim must contain the following information: (1) The recipient's full name; (2) The recipient's medical assistance identification number from the recipient's medical assistance identification card; (3) Date of service; (4) As specified in the provider's contract with the department, the provider's rate of payment for the service provided; (5) The units of service furnished, if more than one; and (6) The provider's name and medical assistance identification number. A separate claim form must be used for each recipient.
Source: 17 SDR 4, effective July 16, 1990; 17 SDR 22, effective August 14, 1990; 18 SDR 78, effective November 4, 1991; 19 SDR 26, effective August 23, 1992; 19 SDR 165, effective May 3, 1993; 20 SDR 149, effective March 21, 1994; 21 SDR 183, effective April 30, 1995; 28 SDR 96, effective December 30, 2001.