Section · Administrative Rules of South Dakota · View on sdlegislature.gov ↗
A claim for services provided under this chapter must be submitted on a form or in an electronic format that contains the following: (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 as required under chapter 67:16:26; (4) Beginning and end dates of service. A provider may only bill for one month at a time; (5) The number of covered days; (6) The total charges; (7) The type of bill; (8) The provider's name, address, telephone number, and National Provider Identification number; (9) The applicable diagnosis codes; (10) The patient status code indicating the patient's status on the final day of service of the billing period; and (11) The revenue code identifying the specific accommodation, ancillary service, or billing calculation. A separate claim form must be submitted for each recipient.
Source: 17 SDR 4, effective July 16, 1990; transferred from § 67:16:04:31, 18 SDR 67, effective October 13, 1991; 40 SDR 122, effective January 7, 2014; 42 SDR 51, effective October 13, 2015; 52 SDR 126, effective July 1, 2026.