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Prior Authorization

Out-of-State

On January 13, 2014 South Dakota Medicaid implemented a Prior Authorization requirement on all inpatient hospitalizations more than 50 miles outside of the state of South Dakota, except Bismarck, North Dakota.

As of September 1, 2014 South Dakota Medicaid will expand the Out-of-State Prior Authorization  requirement to most medical services received more than 50 miles outside of the state of South Dakota, except Bismarck, North Dakota.   This applies to all Medicaid recipients, except those in foster care. 

Prior Authorization by South Dakota Medicaid does not guarantee payment. The provider must be an enrolled South Dakota Medicaid provider and must submit a timely and accurate claim. Also, the recipient must be eligible for coverage on the date of service.

Out-of-state providers not currently enrolled in South Dakota Medicaid must obtain prior authorization and provide the service before provider enrollment can be completed. See FAQs for additional information.

Frequently Asked Questions

Provider Communication

Recipient Notice

Documentation Requirements for Prior Authorization Requests:

Submit completed documentation to:

  • Department of Social Services
    Division of Medical Services
    Nurse Consultant
    700 Governors Drive
    Pierre, SD 57501
  • Phone: 605-773-3495
  • Fax: 605-773-5246