S.D. Admin. R. 67:16:26:07.02

Current through Register Vol. 51, page 57, November 12, 2024

Section 67:16:26:07.02 - Certain claims eligible for payment before third-party benefits recovered - Department to pursue reimbursement

A provider is eligible to receive payment for the full amount allowed under the department's payment schedule while the department pursues reimbursement from third-party sources in the following situations:

(1) The claim is for services for early and periodic screening, diagnosis, and treatment, provided under chapter 67:16:11, except for psychiatric inpatient services, nutritional therapy, nutritional supplements, and electrolyte replacements;

(2) The third-party liability is derived from an absent parent whose obligation to pay support is being enforced by the department and 100 days from the date of service have elapsed;

(3) The probable existence of third-party liability cannot be established at the time the claim is filed;

(4) The claim is for nursing facility services reimbursed under chapter 67:16:04; or

(5) The claim is for services provided by a school district under chapter 67:16:37.

S.D. Admin. R. 67:16:26:07.02

16 SDR 226, effective 6/24/1990; 17 SDR 184, effective 6/6/1991; 31 SDR 39, effective 9/29/2004; 46 SDR 050, effective 10/10/2019; 47 SDR 038, effective 10/6/2020

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1(2)(4).

Pay and chase provisions, 42 C.F.R. § 433.139.