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Provider Enrollment: Getting Started

During the registration process you will be led through many steps with multiple elements. You may not be required to complete every step or element. Please review the following information and collect your needed information prior to your registration date.

  • Appropriate system requirements. Click here to view system requirements.
  • Basic information, including Name, Tax ID, National Provider Identifier (NPI) and other basic details.
  • Physical business location address and mailing address for your main location and any satellite clinics or locations.
  • Specialty and Sub-specialty information for any NPI you will register (taxonomy).
  • Ownership information, including Social Security Numbers (SSN) for all owners (if applicable).
  • Federal Tax Details.
  • License and certification details specific to the provider's specializations. Licenses must cover all dates of the requested enrollment period.
  • Method you will use to submit transactions and receive data from South Dakota Medicaid. IF you use electronic batch methods, this information includes the electronic data interchange (EDI) transactions used, EDI contact information and EDI software details, and Clearinghouse submitter ID if available. Click here for a list of enrolled Billing Agents/Clearinghouses
  • Servicing (rendering) provider details for providers associated with your group or organization (birth date, SSN, DEA number, professional license number, NPI, taxonomy, specialty and other certifications).
  • Information about who will do the billing for servicing (rendering) providers, for example clinics. This includes designation of billing intermediaries as well as group providers who bill on behalf of their rendering practitioners.
  • Payment details and preference including bank account information needed to support direct deposit payments via electronic funds transfer.
  • Information needed for the electronic receipt of the Remittance Advice (RA) if you choose to receive electronic RA's.
  • Out-of-state providers who are not enrolled as a South Dakota Medicaid provider must obtain prior authorization and provide the approved service(s) prior to enrolling in South Dakota Medicaid. If Prior Authorization is required, providers should first submit the Prior Authorization Request Form found here.  If the request is approved, the provider will receive written notification stating the determination was made pending enrollment.  The provider must submit the resulting claim and the written prior authorization approval notification with the Provider Enrollment documentation. 
  • South Dakota has timely filing rules for claims submissions. Initial claim submission is generally required within six months from the date of service. Please refer to South Dakota Administrative Rule 67:16:35:04 for specific details.  Failure to enroll and submit enrollment documentation in a timely manner will not circumvent timely filing claim rules.

Provider Enrollment

Please review the following enrollment types listed below to determine your appropriate enrollment process.

Training for each enrollment type is available on the training page and can be accessed by using the links under each enrollment type description.

The Provider Agreements establish a contractual relationship between the Department of Social Services, Division of Medical Services and the provider enrolling to ensure the provider adheres to all rules and regulations established by Federal Government, the State of South Dakota via administrative rule and codified law. Providers may be required to submit supplemental documents based on information entered into SD MEDX during the enrollment process such as electronic funds transfer verification, licenses and addendums to the provider agreements. All providers are required to complete and sign a provider agreement with original signature. Documents requiring an original signature should be sent via mail.

  • Billing Agents
    • All new Billing Agent enrollments must be completed utilizing SD MEDX. (Counties pricing claims via Medicaid will, also, enroll as billing agents). This online process replaces paper enrollment for Billing Agents. All providers who are associated to a Billing Agent will not be able to complete a new enrollment until the Billing Agent has been approved in SD MEDX. Click here for a list of enrolled Billing Agents/Clearinghouses
    • Training Information
    • SDMA Trading Partner Agreement
    • Billing Agents: ENROLL NOW!
  • Group Provider
  • Facility/Agency/Organization/Institution/Pharmacy (FAOIP)
    • A Facility/Agency/Organization/Institution/Pharmacy (FAOIP) provider is an entity that provides health care services. A FAOIP includes Hospitals, Nursing Facilities, Laboratories, Pharmacies, etc., and have a Type 2 NPI number associated to them. All providers who are associated to a FAOIP will not be able to complete a new enrollment until the FAOIP has been approved in SD MEDX.
    • Training Information
    • SDMA Provider Agreement
    • SDMA Trading Partner Agreement
    • FAOIP Providers: ENROLL NOW!
  • 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 the South Dakota Medical Assistance Program (SDMA). The Billing Provider that is associated to this applicant type submits claims and receives payments for the rendering/servicing provider. This Billing Provider must be approved in SD MEDX prior to the submission of a new enrollment application for a servicing provider.
      • Atypical Providers
        • Atypical Facility/Agency/Organization/Institution (FAOI)
        An Atypical Facility/Agency/Organization/Institution (FAOI) provider is an entity that provides health care or support of healthcare services. An Atypical FAOI includes Renal Transportation, Community Transportation, Non-Emergency Medical Transportation and specialized care for the elderly to help them remain in their home. The distinguishing factor for an atypical FAOI provider is that FAOI provider is unable to obtain an NPI.
      • Atypical Individual Providers
        An Atypical Individual Provider is a Renal Transportation, Community Transportation, Non-Emergency Medical Transportation, or specialized Adult Servicing and Aging Provider that provides services directly or indirectly related to medical care to Medicaid Recipients but the individual provider does not qualify to obtain an NPI.

      Formal Addendums to the South Dakota Medical Assistance Provider Agreement

      These addendums serve as additional documents to the South Dakota Medical Assistance Provider Agreement for specific provider types. These forms establish contractual relationships with the specific provider types to ensure the adherence to rules and regulations established by South Dakota Administrative Rule and Codified Law, as well as the Federal Government.

      Addendum to the Provider Agreement to participate in the South Dakota Medical Assistance PRIME Program (Managed Care) as a Primary Care Provider

      Medical assistance providers who anticipate participating in the South Dakota Medical Assistance PRIME Program may use this Addendum to the Provider Agreement to enroll as Primary Care Provider (PCP) in the Managed Care Program.

      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.