Section · Administrative Rules of South Dakota · View on sdlegislature.gov ↗
claims eligible for payment before third-party benefits recovered -- Department to pursue reimbursement. A provider is eligible to receive payment for the full amount allowed under the department's payment schedule while the department pursues reimbursement from third-party sources in the following situations: (1) The claim is for services for early and periodic screening, diagnosis, and treatment, provided under chapter 67:16:11, except for psychiatric inpatient services, nutritional therapy, nutritional supplements, and electrolyte replacements; (2) The third-party liability is derived from an absent parent whose obligation to pay support is being enforced by the department and 100 days from the date of service have elapsed; (3) The probable existence of third-party liability cannot be established at the time the claim is filed; (4) The claim is for nursing facility services reimbursed under chapter 67:16:04; or (5) The claim is for services provided by a school district under chapter 67:16:37.
Source: 16 SDR 226, effective June 24, 1990; 17 SDR 184, effective June 6, 1991; 31 SDR 39, effective September 29, 2004; 46 SDR 50, effective October 10, 2019; 47 SDR 38, effective October 6, 2020.