South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:33 - Provider requirements
Section 67:16:33:02 - Participating provider

To receive reimbursement for covered medical services which are medically necessary and which are provided to eligible recipients, a provider must have a provider agreement with the department. The agreement must be signed by the individual who is requesting to become a participating provider or by an agent of the facility or corporation that is requesting to become a participating provider and approved and signed by the department. Only those individuals or facilities which meet licensure and certification requirements listed in this article may be participating providers.

Upon department approval, the department shall notify the provider in writing of the effective date of the agreement and the provider identification number. Under an approved provider agreement, the participating provider agrees to submit claims only for those services or supplies which meet the requirements of this article, are within the provider's service limits listed in this article, are medically necessary, and are actually furnished to an eligible recipient on or after the effective date of the provider agreement. The department may terminate a provider agreement if the participating provider fails to meet any of these requirements.

An agreement with a participating provider does not become effective until the department has approved and signed the agreement. A provider may not request reimbursement for covered services provided before the effective date of the provider agreement.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Covered services must be medically necessary, § 67:16:01:06.02; Duration of agreement, § 67:16:33:04.