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Prior Authorization

Provider Information

Prior Authorization Request Services and Forms


South Dakota Medicaid will deny payment to any provider billing for services involving sterilization unless the Medicaid Sterilization Consent Form is in compliance with the following:

  • The Medicaid Sterilization Consent Form must be completed according to instructions and attached to the claim
  • If the actual method of sterilization does not match the Consent to Sterilization and Physician’s Statement sections, attach medical records documenting the difference between the planned procedure and the performed procedure to the claim.  

Detailed instructions are included with the Medicaid Sterilization Consent Form.
Additional information about the Medicaid Sterilization Consent Form is available in the South Dakota Medicaid Professional Services Billing Manual.  

Attach the completed Medicaid Sterilization Consent Form to the claim and submit to:

South Dakota Department of Social Services
Division of Medical Services
700 Governors Drive
Pierre, SD 57501

Phone: (605) 773-3495
Fax: (605) 773-5246