67:16:41:11. Prior authorization. A mental health provider must have prior authorization from the department before providing any service listed in § 67:16:41:09 which will exceed the limits established in this chapter. Authorization is based on documentation submitted to the department by the mental health provider. The documentation must include the provider's written treatment plan, the diagnosis, and the planned treatment. Failure to obtain approval from the department before providing the service is cause for the department to determine that the service is a noncovered service.
The department may verbally authorize services; however, the department must verify a verbal authorization in writing before the services are paid.
Services which exceed the established limits are subject to peer reviews according to § 67:16:41:15.
MENTAL HEALTH SERVICES BY INDEPENDENT PRACTITIONER
67:16:01:06.02. Covered services must be medically necessary. Services covered under this article must be medically necessary. To be medically necessary, the covered service must meet the following conditions:
Mail or fax your completed form and documentation to:
Division of Medical Services
700 Governors Drive
Pierre, SD 57501