The following Medical Assistance Managed Care forms are available for you to use as needed to either select or change your Primary Care Provider (PCP).
To complete a form, you need to enter the name and recipient identification number for each person requesting to change or select a provider. You can find this information on each person's Medical Benefits ID Card or on notices you have received from the Department.
Select a PCP by entering the PCP's name and code from the provider list. Scroll through the pages by clicking on the arrow buttons at the bottom of the screen. A “*” next to a provider's name indicates that he or she has a full caseload and is not accepting new patients. Only those who are current patients of a provider who has a full caseload can select that person as a PCP. The PCP ID is valid for enrollment purposes ONLY. This ID is not valid for billing purposes.
Physician assistants, nurse practitioners, certified nurse midwives and medical residents may be listed on the provider list but are not primary care providers. To access medical care from these providers, select the primary care provider they are listed under.
Online Provider List
Provider Selection Form
Provider Change Form
If you have any questions about available providers or completing a form, please contact Medical Services at (605) 773-3495 or by email at Medical@state.sd.us. You may also contact your local office for assistance.
Mail the completed form to: