S.D. Admin. R. 20:06:27:06

Current through Register Vol. 51, page 67, December 16, 2024

Section 20:06:27:06 - General provisions for the filing and processing of claims

Health care practitioners, institutional care practitioners, and issuers shall file and process claims in the following manner:

(1) Health care practitioners and institutional care practitioners shall file claims in a manner consistent with the requirements of this chapter. Claims filed in paper form must be printed on 8.5 x 11-inch paper;

(2) Issuers shall accept forms submitted in compliance with this chapter for the processing of claims;

(3) Health care practitioners, institutional care practitioners, and issuers shall:

(a) Use and accept HCFA Form 1500, HCFA Form 1450, and J512 Form and the instructions for these forms in the billing of patients or their representatives and filing claims with issuers; and

(b) Modify their billing and claim reimbursement practices to encompass the coding changes for all billing and claim filing by the effective date of the changes set forth by the developers of the forms, codes, and procedures required under this chapter.

S.D. Admin. R. 20:06:27:06

22 SDR 97, effective 12/18/1995.

General Authority: SDCL 58-12-14.

Law Implemented: SDCL 58-12-12.

HCFA Form 1500 (12/90), in effect as of May, 1995, Health Care Financing Administration. Copies may be obtained from the American Medical Association, P.O. Box 7046, Dover, DE 19903-7046. Cost: Carton of 1,000, $67.95. HCFA Form 1450: UB-92 HCFA-1450, in effect as of June 30, 1995, Health Care Financing Administration, U.S. Department of Health and Human Services. Copies may be obtained from the American Medical Association, P.O. Box 7046, Dover, DE 19903-7046. Cost: Carton of 1,000, $67.95. Form J512, adopted in 1994, American Dental Association. Copies may be obtained from the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Cost: $25.20, plus $3.95 for shipping and handling.