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Provider Communication

South Dakota Medicaid utilizes multiple resources to communicate information about initiatives, policy changes, and program updates to enrolled providers. Recent communications are listed here. To ensure you receive future communication, join the Division of Medical Services listserv.

Note: Not all communications are sent via the listserv. In some cases, targeted communication is sent directly to a specific provider group/taxonomy type.  Once communication has been sent out, the communication will be added to the South Dakota Medicaid Provider Bulletins list.

South Dakota Medicaid Provider Bulletins

These messages are recent policy changes and program updates. To ensure you receive future communication, join the Division of Medical Services listserv.

COVID-19 Provider Communications

2023 Provider Bulletins

September Medicaid Expansion Claims
Dental Anesthesia
Federal Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) Stand-Alone Vaccine Visit Reimbursement
Balance Billing and Billing Medicaid Recipients
Summer Provider Newsletter
July 30-Month Well-Child Visits
Medicaid Expansion and Professional Claims
Authorized Representatives and Medicaid Applications
Back to School and Well-Child Visits
Primary Care Providers (PCPs) Per Member Per Month Payments
June July 1, 2023 Fee Schedules
Continuous Glucose Monitors and Supplies Coding and Claims
Spring Provider Newsletter
Medicaid Expansion Eligibility and Coverage Start
Community Health Worker Diagnosis Codes
May Expiration of COVID-19 Public Health Emergency
Health Status Report Now Available
Indian Health Service (IHS) Servicing Provider Referrals and Cost-Shares
Payment Error Rate Measurement Reporting Year 2024
Medicaid Expansion Webinars
Public Health Emergency Unwinding Changes to Coverage
April Pre-Admission Screening and Resident Review (PASRR) 1135 Waiver Termination Notice
Developmental Screenings
Claim Documentation
February Important Changes Coming Soon to Medicaid Eligibility
Updated Provider Enrollment Claim Submission Extension
Winter Provider Newsletter
Community Health Worker (CHW) Agency Billing
Ambulatory Payment Classification (APC) Ratio of Cost to Charge and Fee Schedule
January Well-Child Visit Reimbursable Services
ePA for Pharmacy Claims

 

2022 Provider Bulletins

December Narrow Therapeutic Index
Grant Fund Opportunity
November Fall Provider Newsletter
Tribal Services Manager
Money Follows the Person
November 2022 Payroll Changes
October Extra Payroll
September New Data Sources for South Dakota Health Link
Dental Services Update
Durable Medical Equipment Providers in the Sioux Falls Area
Independent Mental Health Practitioner Administrative Rule Change
Podiatric Services Administrative Rule Change
August Community Health Worker Resources and Tools
Summer Provider Newsletter
July Reducing an Unprecedented Rise in Syphilis Rates
PCP Provider Scorecard and Provider Resources
Extra Payroll
July 1, 2022 Fee Schedules
June Provider Enrollment Claim Submission Extension
May Development Screening
Indian Health Service (IHS) Servicing Providers Licensure and Referrals
Behavioral Health Materials Information
Spring Provider Newsletter
Initial Prenatal Visit Reporting
March Metabolic Screening and Behavioral Health
February Winter Provider Newsletter

2021 Provider Bulletins

December Driver and Traffic Violation Disclosure Requirements
November Provider News Fall 2021
October Chiropractor Coverage and Billing Requirements
September Federal PDMP Requirements for Prescribers
Primary Care Providers and Oral Health
August Flu Vaccines
Prescription Drug Monitoring Program Requirements
July Provider News Summer 2021
Well-Child Provider Scorecard and Resources
Telemedicine and Telephonic Services Updates
June Provider News Spring 2021
Dispensing Fee Increase
May Provider Enrollment (PE) Portal & Revalidation
April Online Provider Selection Tool for the PCP and HH Programs
COVID-19 FAQ Updates
March Provider Enrollment Portal Accounts
COVID-19 FAQ Updates
February Pharmacy Administered COVID-19 Vaccines Instructions
CHART Bulletin
January COVID-19 FAQ Updates

2020 Provider Bulletins

December Provider Enrollment Data Access
Fall 2020 Provider Newsletter
Provider Bulletin: COVID-19 Vaccination
90 Day Fill
November APPs Eligible for PCP Program
Provider Bulletin COVID-19 FAQ Update November 2020
UB-04 Claim Submission on the Medicaid Portal
September Provider Bulletin FAQ Update September 14, 2020
August Provider Bulletin HHS PRF How to Guide
HHS Medicaid Provider Relief Fund - Eligible Providers and Extended Application Deadline
Summer 2020 Provider Newsletter
July HHS Medicaid Provider Relief Fund Webinar
HHS PRF Extended Deadline
June FY21 Fee Schedules
Provider Bulletin: Special Payroll June 29th, 2020
Provider Bulletin: COVID-19 FAQ Updates
Provider Bulletin: HHS Announcement
Spring 2020 Provider Newsletter
May Executive Order 2020-26 Medicaid Flexibilities
Hospice Provider Manual
Coronavirus (COVID-19) Frequently Asked Questions
COVID-19 Telehealth Updates
April Coverage of COVID-19 Testing and Treatment for the Uninsured
Medicaid Postpartum Coverage and Elective Postpartum Procedures
COVID-19 Out of State Transfer Prior Authorization Process
Ensure Continued Prompt Payment of Claims
Changes to Silver Diamine Fluoride (D1354) Criteria
March IHS High Dollar Prescriptions
1135 Waiver CMS Approval March 29, 2020
1135 Waiver CMS Approval March 26, 2020
1135 Waiver Submission
SD Medicaid Communications
IHS Contracted Services Telemedicine Claims
Winter 2019 Provider Newsletter
Coronavirus (COVID-19) Frequently Asked Questions
South Dakota Medicaid Office Closure March 16 – March 20
Paper Communication Requests and Reviews (Appeals)
February Anesthesia Manual
Definitive Drug Testing CPT Codes
January Updated Incontinence Supplies Service Limit
Service Limit Inquiry on the Medicaid Portal

2019 Provider Bulletins

December FQHC/RHC Policy Clarifications
Pharmacy Cost of Dispensing Survey
Payroll Date Changes Due to Holidays
November Fall 2019 Provider Newsletter
2019 Administrative Rules Updates
Clinical Diagnostic Laboratory Services Reimbursement
Well-Child Check-up Reimbursement
October Incontinence Supplies Prior Authorization
Claim Status Inquiry on the Provider Online Portal
September OptumRx Fax Change
Claim Submission on the Provider Online Portal
August Summer 2019 Provider Newsletter
July Breast Pump Coverage
June Incontinence Supplies
Urgent Care Visits
New FQHC/RHC Services Provider Manual
April Community Health Workers
Hospice Notification Form
IHS Referrals
March April 1, 2019 Fee Schedules
Opioid Prescription Changes
January SLP Telehealth Services
2019 CPT and HCPC Update
Fall 2018 Provider Newsletter
Public Health Nursing Services

2018 Provider Bulletins

November

Pharmacy Administered Vaccines and Lab Tests
Opioid Prescription Changes
340B Drug Coverage
Newly Eligible Independent Mental Health Practitioners
October Pharmacy Administered Vaccines and Lab Tests
Opioid Prescription Changes
Adult $1,000 Annual Dental Maximum
Dietician and Nutritionist Services
September Taxonomy Reminder Bulletin
Opioid Prescription Changes
August Summer 2018 Provider Newsletter
Appeals
July Substance Use Disorder (SUD) Bulletin
Medicare Crossover Ordering Physician Reminder
June Special Payroll June 28, 2018
Claims Review and Coverage Request
Outpatient Retail Pharmacy Reimbursement Changes
NCCI and MUE System Update
Dakota at Home
May Opioid Prescription Changes
April Home Health Licensed Practical Nurse Services
Ambulance Mileage Bulletin
Community Transportation Mileage Bulletin
Silver Diamine Fluoride
Spring 2018 Provider Newsletter
South Dakota Medicaid Communication Log
South Dakota Medicaid Updates
March April 1, 2018 Fee Schedules
February Portal Audit Log and Eligibility Inquiry Update
January NPI Requirements Table
DME Administrative Rule Changes

2017 Provider Bulletins

December Assisted Living Claims Submission
Mobility Device Prior Authorization
November Pharmacy Point - of - Sale Transition LIVE
Pharmacy Point - of - Sale Transition
August Prior Authorization Updates
July Special SD Medicaid Payroll July 6, 2017
June Timely Claims Filing & Revalidation
May CORRECTION ** South Dakota Medicaid Billing Requirements for Rendering NPI and Taxonomy
South Dakota Medicaid Billing Requirements for Rendering NPI and Taxonomy
January Well Child Services
UPDATE ** Medicaid Online Portal

2016 Provider Bulletins

December Special Payroll December 15, 2016
Telemedicine Services
ATTENTION: Professional Services Providers - ACA NPI Requirements
November Medicaid Online Portal
October Telephone Lines
September ATTENTION: School Districts - OCR Paper Claims Filing Update
ATTENTION: DME Providers - OCR Paper Claims Filing Update
ATTENTION: Vision Providers - OCR Paper Claims Filing Update
Reminder: Out-of-State Services Require Prior Authorization
August Ambulatory Payment Classification (APC) FAQ
NDC Cheat Sheet
ATTENTION: Health Department Clinics - ACA NPI Requirements
July ATTENTION: Transportation Providers - OCR Paper Claims Filing Update
Prenatal Care for Unborn Children Program
Paper Remittance Advices
Medicaid Coverage of BRCA Gene Analysis
June New Medicaid Eligibility Group: Prenatal Care for Unborn Children Program
ATTENTION: ASA Nursing Home & Assisted Living Providers - PERM Errors
ATTENTION: Institutional Providers - ACA NPI Requirements
OCR Paper Claims Filing Guidelines
Remittance Advice Survey
OCR Paper Claims Submission Tips
Electronic Remittance Advice Enhancement
May NDC Edit Update
April IMPORTANT NOTICE: OCR Paper Claims Billing Guidance
NPI Use for Pharmacy Point of Sale Providers
Paper Remittance Advices
February OCR Paper Claims Submissions
Billing Guidance: Timely Filing and OCR Paper Claims Submissions
January Billing Guidance: NDC and State Supplied Vaccines
Billing Guidance: Timely Filing, Transportation Services Electronic Submissions, and Paper Claims Submissions

2015 Provider Bulletins

December Billing Guidance: Claim Filing Tips
November Billing Guidance: Paper Claim Submissions
Billing Guidance: Sports Physicals & Well-Child Exams
October ICD-10 Update: Oct. 30, 2015
ICD-10 Update: Oct. 23, 2015
ICD-10 Billing Tips
Billing Guidance: NDC/Procedure Code Denial Edit
Billing Guidance: CMS 1500 Diagnosis Indicator
ICD-10 Update: Oct. 5, 2015
September ICD-10 Update: Sept. 4, 2015
Billing Guidance: Claim Filing Tips
Are you ready for ICD-10?
August Applied Behavior Analysis Coverage Fact Sheet
Billing Guidance: NDC Numbers and J-Codes
ICD-10 Update: Aug. 7, 2015
ICD-10 Update: Aug. 14, 2015
ICD-10 Update: Aug. 21, 2015
ICD-10 Update: Aug. 28, 2015
July Billing Guidance: Social Security Numbers on Paper Claims
ICD-10 Update: July 23, 2015
ICD-10 Update: July 17, 2015
ICD-10 Update: July 10, 2015
ICD-10 Billing Clarification for Dental and School-Based Services
June SFY 2016 Provider Fee Schedules
ICD-10 Webinar
ICD-10 Testing Update
ICD-10 Testing Information
May ICD-10 Provider Readiness Survey
Billing Guidance: Telemedicine and UB Claim Forms
ICD-10 Listserv
April ICD-10 Website and Provider Readiness Survey
January Billing Guidance: Recipient Name Verification

South Dakota Medicaid Provider Training

  Health Status Report Training | User Guide
  Online Selection Tool Training | PowerPoint
August 2022 Physical Therapy Presentation | PowerPoint
June 2022 Chiropractor Presentation | PowerPoint
August 2018 DME Educational Letter with Crosswalk Codes
June 2018 School District Presentation June 2018
June 2018 Provider Portal Training
April 2018 Birth to Three Presentation
March 2018 Provider Credit Balance Reporting F.A.Q.
January 2018 Assisted Living Billing CMS 1500 Q and A
January 2018 Assisted Living Billing from UB-04 to CMS 1500 Power-point
January 2018 Provider Credit Balance Reporting
February 2017 Transportation Training

License for Use of Physicians' Current Procedural Terminology (CPT)

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Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2015 American Medical Association (AMA).

You, your employees, and agents are authorized to use CPT only as contained in the following authorized materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, 515 North State Street, Chicago, IL 60610. Applications are available on the AMA website, http://www.ama-assn.org/go/cptExternal_Link.

Applicable FARS/DFARS restrictions apply to government use. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-l(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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