January 2013

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Primary Care Provider Enhanced Payments
On December 28, 2012 the Division of Medical Serivces distributed a message via its listserv regarding implementation of enhanced payments for certain services furnished by certain primary care physicians and charges for vaccine administration under the Vaccines for Children Program. A second message with additional clarification was sent on January 8, 2013. South Dakota Medicaid has assembled a list of frequently asked questions to assist providers with common questions. You may access more information, including the list of frequently asked questions and self-attestation form online.

Billing Code Changes

Effective January 1, 2013 South Dakota Medicaid adopted the 2013 CPT revisions for certain services. For dates of service beginning January 1, 2013, South Dakota Medicaid will no longer accept codes that were discontinued in the 2013 update. Providers should bill using the new CPT codes to avoid errors. Fees for the new codes are posted on the appropriate fee schedules. Fee schedules are available online.

Important Contact Numbers

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Telephone Service Unit for Claim Inquires:

  • In State Providers:
  • Out of State Providers:

Provider Response (Enrollment and Update Information):

Medical Assistance for Recipients:

Dental Claim and Eligibility Inquiries:

Managed Care Updates:

Pharmacy Prior Authorization:

Medical & Psychiatric Prior Authorization:

Recipient Premium Assistance:

Welfare Fraud Hotline:

Medicare: 1-800-633-4227

Division of Medical Services Fax:

Provider Enrollment Fax:

Division of Medical Services Welcomes new Director - Kirby Stone

Kirby comes to us from Colorado with a background in long-term care facility management, and state and county government. She has overseen multiple human and social service programs at the county level including family and children's Medicaid, adult Medicaid, adult protection, TANF, supplemental nutrition assistance program, low income energy assistance program, fraud investigation and recovery, and child support enforcement. While working at Colorado's Department of Health Care Policy and Financing, she oversaw the Medicaid program for nursing facilities, assisted living facilities, and some HCBS waiver programs. Kirby's new responsibility is to oversee the South Dakota Medicaid program, and to ensure effective and efficient service delivery to Medicaid recipients and the state's Medicaid providers.

Kirby earned her Bachelor's degree in Business Administration/Management from Western State College; her Master's degree in Gerontology - Administration of Aging Programs from the University of Northern Colorado; and her Doctorate in Education and Human Resource Studies with a specialization in Human Resource Development and Public Policy from Colorado State University.

Health Home Workgroup Concludes its Formal Work

The Health Home Workgroup was formed to address the Medicaid Solution Workgroup's Recommendation 1: Implement a Heath Home Initiative for Medicaid Enrollees. The Health Home Workgroup began its work on April 10, 2012 and concluded with its final in-person meeting on October 30, 2012.

The Department of Social Services will submit two State Plan Amendments (SPAs) to implement Health Homes, one for the Behavioral Health Health Home and one for the Primary Care Provider Health Home. The Department anticipates submitting both SPAs by April 1, 2013 for a July 1, 2013 implementation date.

The Department is currently working to finalize implementation plans, including an application for prospective Health Homes, training for Health Homes, and data reporting criteria and collection systems. The Department is also calculating the per member per month reimbursement for the provision of the six Health Home Core Services based on prospective cost reports submitted by members of the Health Home Workgroup. The six Core Services include comprehensive case management, care coordination, health promotion, comprehensive transitional care, patient and family support, and referrals to community and social support service.

Based on the robust stakeholder involvement throughout the planning process, the Department anticipates a successful implementation resulting in positive outcomes for eligible Medicaid recipients.

EHR Incentive Payment Program

In 2012, South Dakota Medicaid distributed $8,440,241.71 in electronic health record (EHR) incentive payments to 108 eligible professionals and 11 eligible hospitals.

On November 5, 2012 the South Dakota Medicaid EHR Incentive Payment Program announced the acceptance of Stage 1 Meaningful Use attestations. To receive an EHR incentive payment for Stage 1 Meaningful Use and any future stages, eligible professionals, eligible hospitals and Critical Access Hospitals (CAHs) must show they are “meaningfully using” their EHRs by meeting thresholds for a number of objectives.

The announcement of Stage 2 Meaningful Use also included some changes to Stage 1. These changes are being finalized and will be announced at a later date.

More information about the Medicaid EHR Incentive Payment Program can be found at

Employee Spotlight:

As the pharmacy consultant for the Division of Medical Services, Mike Jockheck is responsible for managing the prescription drug benefit. This includes working with pharmacists, physicians, vendors, committees, and other stakeholders to ensure a coordinated and comprehensive pharmacy benefit is available to Medicaid recipients.

Before joining Medical Services, Mike was the pharmacy consultant with the Division of Adult Services and Aging. In that role Mike conducted retrospective drug utilization review activities, which he continues to do today, and helped establish the RxAccess program.

Mike was raised in Pierre, served two years in the U. S. Army and five years in the National Guard while obtaining his degree in pharmacy from South Dakota State University. Mike worked in the retail pharmacy industry as a pharmacy manager before joining the Department of Social Services.

In his off time Mike enjoys outdoor activities, cheering (and occasionally ranting about) the Vikings and Twins, and attending with his wife, the various events of their two children.


Comments or questions?
Contact Medical Services

South Dakota Department of Social Services

Division of Medical Services
700 Governors Drive
Pierre, SD 57501
Phone 605.773.3495

Fax 605.773.5246

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