South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:35 - Claims
Section 67:16:35:01 - Definitions

(1) "Adjustment/void claim form," a form that is used to adjust or void a previously paid claim;

(2) "Cross-over claim form," a form used to record the Medicare co-insurance and deductible payments for recipients who are eligible for both Medicare and Medicaid;

(3) "Denied claim," a claim that does not qualify for a medical assistance payment;

(4) "Pended claim," a claim which has not been paid or denied but is being reviewed for final action; and

(5) "Remittance advice," a document sent to the provider which contains the status of claims submitted by that provider.