Section · Administrative Rules of South Dakota · View on sdlegislature.gov ↗
A claim for services provided under this chapter must be submitted on a form 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 or cost-sharing payments from this charge; (7) The applicable procedure codes for services covered under § 67:16:28:04; (8) The units of service furnished, if more than one; and (9) 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; 34 SDR 68, effective September 12, 2007; 43 SDR 80, effective December 5, 2016; 52 SDR 126, effective July 1, 2026.