South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:35 - Claims
Section 67:16:35:03 - Claims limited to items and services covered under article

A provider may only submit claims for those supplies and services provided which the provider knows, or should have known, are covered under the provisions of this article. A provider other than a school district, may not submit claims for services provided to children under 21 years of age which the provider knows or should have known are listed in the child's individual education plan.

The submission of a claim containing miscoding that may result in inflated reimbursement or in reimbursement for noncovered services under this article is considered abuse of the program and possible fraud and may be cause for terminating the provider agreement.

General Authority: SDCL 28-6-1(1)(2).

Law Implemented: SDCL 28-6-1.

School districts, ch 67:16:37.