Lynne A. Valenti
Cabinet Secretary

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Provider Enrollment: New Providers

SD Medicaid has an online enrollment application process. In addition to the online application, certain supporting documentation must be sent via email, fax, or mail following application completion. Applications and accompanying documentation not completed and received within 30 days of the application start date will be rejected or denied. Rejected and denied applications cannot be revived and will require the provider to begin the application process over. SD Medicaid’s enrollment is based on NPI and there can be multiple locations noted on one application. There is currently no application fee charged.

Eligibility Criteria:

  • Providers desiring to enroll must be a type of provider recognized by SD Medicaid. Refer to our list of eligible providers.
  • Out-of-state providers generally must obtain prior authorization for services. If a prior authorization number is issued, it must be included on the claim submitted with the enrollment documentation.
  • Out-of-state providers must submit a claim for services that meets prior authorization and timely filing requirement as part of the enrollment documentation. Out of state providers without services that meet timely filing requirements will not be eligible to enroll. Most claims must be submitted within six months from the date of services. Please refer to South Dakota Administrative Rule 67:16:35:04 for specific details.
  • Failure to obtain prior authorization, submit enrollment documentation, or complete the enrollment process in a timely manner will not circumvent the timely claim filing requirements.
  • Applications and accompanying paperwork not completed and received within thirty days of the application start date will be rejected or denied. Rejected and denied applications cannot be revived and will require the provider to begin the application process over.

Provider Application Types

South Dakota Medicaid has five types of online application forms. With the exception of billing agents, all applications require a valid NPI. Please review the following application types below to determine your appropriate online enrollment process and start the application.

To determine what information will be required on the application, refer to the corresponding Quick Reference


Guide

  • Billing Agents Start Online Billing Agent Application
  • Group Provider
      • A Group provider is an organization of individual providers that provide medical or dental services. A Group provider has a Type 2 NPI and rendering/servicing providers with a Type 1 NPI must be associated to the Group provider.
      • New servicing providers not known to SD MEDX at the time of the group application should have the individual application started from within the group record under the servicing provider step.
      • Training Information:
      • Required Paperwork:
    Start Online Group Application
  • Facility/Agency/Organization/Institution/Pharmacy (FAOIP)
  • Tribal or Indian Health Services Provider
  • Individual Providers
    • Servicing Individual Providers
      • A Servicing Individual is a provider who provides services through a Group, Facility, Agency, Organization, Institution, Pharmacy, Tribe, Indian Health Services or Regular Individual Provider. A servicing provider does not bill directly to South Dakota Medicaid. A Billing Provider that is associated to the individual submits claims and receives payments for the servicing provider. Payments are reported under the Billing Provider’s FEIN, not the individual’s SSN. If the Billing Provider is not approved in SD MEDX prior to starting the individual application, make sure the individual application is started from within the entity application.
    • Regular Individual Providers
      A Regular Individual Provider is a provider that owns his/her own practice that is not incorporated. This provider will receive payments directly from SD Medicaid for services rendered at their practice which is required to be reported under the provider's SSN. A provider who desires to have payments reported under a FEIN or TIN must obtain a Type 2 NPI and enroll as a Group and Servicing Individual Provider. A Regular Individual Provider may associate to other entities while Servicing Individual providers may associate to other entities and Regular Individual Providers.

Restraint and Seclusion Attestation Form for PRTF Facilities

The Centers for Medicare and Medicaid Services (CMS) requires all State Medicaid Agencies to obtain an annual attestation form from all residential treatment facilities providing psychiatric services to individuals under age 21. This form ensures compliance, on the part of the facility, with the federal regulations that govern the use of restraint and seclusion as codified in 42 CFR §§ 483 Subpart G. The attestation form must be completed and signed by an individual who has the legal authority to obligate the facility.