67:54:06:16Claim requirements.
Section · Administrative Rules of South Dakota · View on sdlegislature.gov ↗
A claim for services provided under this chapter must be submitted on a form which contains the following information: (1) The recipient's full name; (2) The recipient's medical assistance identification number from the recipient's medical identification card; (3) The third-party liability information required under chapter 67:16:26; (4) The date of service; (5) The 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 units of service furnished, if more than one, for each procedure; (8) The applicable procedure codes; (9) The type of service; and (10) The provider's name and medical assistance identification number. A separate claim form must be used for each client.
Source: 21 SDR 230, effective July 13, 1995.
General Authority
- SDCL 28-6-1 ↗Amended by HB1239 (2020) — require the costs of nursing homes to be rebased every five years for purposes oAmended by HB1229 (2019) — require optional services through Medicaid to be authorized through special apprAmended by SB30 (2019) — remove certain unnecessary federal references and dates from certain provisions
Law Implemented
- SDCL 28-6-1 ↗Amended by HB1239 (2020) — require the costs of nursing homes to be rebased every five years for purposes oAmended by HB1229 (2019) — require optional services through Medicaid to be authorized through special apprAmended by SB30 (2019) — remove certain unnecessary federal references and dates from certain provisions