South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:26 - Third-party liability
Section 67:16:26:07.01 - Payment provisions when third-party source involves Medicare

If a recipient is eligible for Medicare, the provider must submit a completed claim for payment of services to the Medicare carrier or intermediary. The provider is eligible to receive payment from the department for the deductible and coinsurance as indicated on the explanation of benefits for those physician and outpatient services allowed by the Medicare carrier. Deductible and coinsurance payments for inpatient hospital services are subject to chapter 67:16:03.

The department may not pay for any service that has been denied by Medicare as not medically necessary or reasonable or as not meeting the requirements for submitting a claim.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.