S.D. Admin. R. 67:16:24:06

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

Section 67:16:24:06 - Claim requirements

A claim for services provided under this chapter must be submitted on a form available from the department or the claim may be electronically transmitted through a system approved by the department. The claim must contain the following information:

(1) The recipient's full name;

(2) The recipient's medical assistance identification number from the recipient's medical assistance identification card;

(3) Date of service;

(4) As specified in the provider's contract with the department, the provider's rate of payment for the service provided;

(5) The units of service furnished, if more than one; and

(6) The provider's name and medical assistance identification number.

A separate claim form must be used for each recipient.

S.D. Admin. R. 67:16:24:06

17 SDR 4, effective 7/16/1990; 17 SDR 22, effective 8/14/1990; 18 SDR 78, effective 11/4/1991; 19 SDR 26, effective 8/23/1992; 19 SDR 165, effective 5/3/1993; 20 SDR 149, effective 3/21/1994; 21 SDR 183, effective 4/30/1995; 28 SDR 96, effective 12/30/2001.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Claims, ch 67:16:35.