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Provider Enrollment & Maintenance

SD Medicaid is in process of changing how its provider enrollment data is accessed and stored. A new Provider Enrollment Portal, similar to the Medicaid Portal used for claims, will be used to enroll and access existing provider enrollment data.

The existing provider enrollment applications and record modifications are in process of being reviewed by SD Medicaid and migrated for use in the portal. We apologize for the inconvenience as this means that we are unable to accept any new applications or make updates to existing records unless an exception occurs.

The new Provider Enrollment Portal is expected to come online in late February to early March. Existing billing provider contacts will receive additional communication about administrator account set-up. Information about how to request administrator accounts and complete enrollment activities will be posted to this website in the coming weeks. In the meantime, providers should retain a list of items that will need attention once the portal is online, bookmark this page as a favorite and check back regularly, and sign-up for the Medicaid Provider Enrollment listserv if not already a member.

General Enrollment Information

  • Application and maintenance of records is completed online with any required documentation sent via email
  • No application fee is charged.
  • Enrollment records and documentation must be completed and received within 30 days of starting data capture or it will be denied/rejected.
  • Many attending, ordering, referring, and prescribing providers will be subject to the streamlined enrollment process upon claim submission.
  • Billing and Servicing providers must be a type of provider recognized by SD Medicaid on our provider enrollment chart and provide covered services in order to enroll.
  • Out-of-state providers must submit a claim for services that meets prior authorization and timely filing requirements with the enrollment documentation to be deemed eligible.
    • Timely filing requirements cannot be extended for failure to obtain prior authorization, provide documentation, or submit online enrollment records in a timely manner.
    • Providers should complete their actions at least 30 days prior to timely filing deadlines.
  • Providers are required to maintain their online enrollment records to accurately reflect business operations and eligibility to render and bill for services.

Billing NPI Enrollment

Billing NPI Definition

  • Billing NPI (BNPI) is defined as all Organizational (Type 2) NPIs and any unincorporated individual operating solely under their SSN for tax reporting and whose Type 1 (individual) NPI would be the only one found on claims in the rendering NPI and billing NPI fields.
    • Some examples include group of individuals, agencies, facilities, institutions, suppliers, and transportation.

Description of services and requirements by service.

  • Provider Enrollment Chart
  • Collectives of individual professionals who are going to be billing for the professional services should select a group taxonomy (193200000X or 193400000X) for the BNPI enrollment.

Required documentation

Servicing/Rendering NPI Enrollment

Servicing NPI Definition

  • Servicing NPIs are individual (Type 1) providers rendering services that are billed through an associated BNPI. The payments are reported under the billing provider’s FEIN, not the individual’s SSN.

Description of services and requirements by service.

  • Provider Enrollment Chart
    • Individuals are generally only permitted one taxonomy code unless otherwise noted.
    • Individuals working for multiple entities should advise the entities what taxonomy code is used as consistency is needed.
  • Required documentation
    • All SNPI
    • Certain SNPI
      • Proof of licensure/certification from requested enrollment date to current date
        • Note:  MDs, DOs, PAs, CNPs, and ARNPs, temporarily practicing in SD under a license not issued by SD due to COVID-19 should specifically call this limitation out on their documentation cover sheet or email.  Enrollment eligibility may not start prior to 3/1/2020 and will be terminated following the end of the emergency declaration.
      • Mental Health Services Addendum
      • PCP Addendum
        • Note: Only applies to a physician assistant (effective 11/01/2020), certified nurse practitioner (effective 11/01/2020), certified nurse midwife (effective 11.01.2020), DO or MD in the specializations noted on the form and whose physical servicing location is in SD, within 50 miles of SD, or in Bismarck, ND.   In addition to the form, the information must be captured on the online enrollment record.