Lynne A. Valenti
Cabinet Secretary

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Provider Enrollment: Getting Started

During the enrollment 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 beginning your enrollment application.

  • Appropriate system requirements.
  • Basic information such as, Name, Tax ID, National Provider Identifier (NPI) and other basic details.
  • Addresses for all your locations.
  • Specialization (taxonomy code) used in billing
  • Controlling and ownership information, including Social Security Numbers (SSN) for all owners (if applicable) and managing employees
  • Federal Tax Details.
  • License and certification details specific to the provider's specializations which 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, you will need to know the seven digit SD MEDX ID from your Billing Agent/Clearinghouse and which transactions you are authorizing this entity to send/receive. 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, other certifications, and locations where services are rendered).
  • 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.
  • Out-of-state providers who are not enrolled as a South Dakota Medicaid provider must obtain prior authorization if required and also 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, if prior authorization is required, 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. Claims submitted with enrollment documentation must meet these requirements.

Important Notices:

  • Failure to enroll and submit enrollment documentation in a timely manner will not circumvent the timely claim filing. Out of state providers without services that meet timely filing requirements will not be eligible to enroll.
  • 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.
  • The ability to check the status of a submitted application or to complete an application not yet submitted can be done using Track Enrollment Application.

Provider Enrollment Types

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

Training for each enrollment type can be accessed by using the links under each enrollment type description.

The Provider Agreements establish a contractual relationship between SD Medicaid and the provider enrolling to ensure the provider adheres to all rules and regulations established by the Federal Government and 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 must be sent via mail.

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

Providers who anticipate participating in the South Dakota Medicaid PRIME Program must indicate their desire to be a Primary Care Provider (PCP) in the Managed Care Program on their SD MEDX enrollment record and submit the PCP Addendum.

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.