Lynne A. Valenti
Cabinet Secretary

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Provider Maintenance and Revalidation

Provider Revalidation

  • SD Medicaid is federally required to have enrolled providers complete revalidation activities at least once every five years.
  • SD Medicaid will send a revalidation request to providers upon the provider being selected by SD Medicaid for revalidation.
  • Failure to complete all online enrollment activities and/or providing the required supporting materials will result in termination of the provider agreement.

    2016 Revalidation

  • All providers will be subject to revalidation and will receive notice from SD Medicaid.
    • Revalidation Schedule, subject to change
      • Phase 1 - Beginning the week of 6/23/16
        • Tribal/IHS (enrollment type) and associated individuals eligible for enrollment
        • Community Mental Health Centers and associated individuals eligible for enrollment
        • Substance Use Disorder facilities and associated individuals eligible for enrollment
        • School districts and associated individuals eligible for enrollment
        • FQHC and associated individuals eligible for enrollment
        • RHC and associated individuals eligible for enrollment
      • Phase 2 - Beginning the week of 8/1/16
        • Regular individuals (enrollment type)
        • All providers with base locations in SD that were not in Phase 1.
      • Phase 3 - Beginning the week of 9/1/16
        • All providers with base locations outside of SD that were not in Phase 1.
  • Revalidation notices will include the domain, user name, and temporary passwords to gain access to the provider’s online enrollment record.
  • Revalidation activities include reviewing all online enrollment steps and information and making updates where needed.  For billing providers, this will also include reviewing all steps and information for associated servicing providers.
  • Updated supporting documentation must also be submitted.
  • Supporting documentation can be sent via email to SDMEDXGeneral@state.sd.us with the subject “Revalidation for NPI X” with X being the applicable NPI.  Supporting documentation can also be faxed to 605.773.8520. Please use one coversheet for each NPI and also note the NPI on each sheet of the supporting documentation. Please package up supporting documentation so there is one submission for each NPI that includes all applicable supporting documentation.  SD Medicaid no longer requires original ink signatures on documents and will accept scanned or faxed copies of signatory documents.  

Getting Started

The following information is intended to assist providers in knowing what actions are required during revalidation. If a provider is deemed to be a moderate or high level risk, additional supporting documentation such as fingerprints may be requested by SD Medicaid or an unannounced site visit on behalf of SD Medicaid may be required prior to approval of the revalidation records.

Revalidation Webinar for all Providers: Slides with audio | Slides only

Provider Maintenance

It is the provider’s responsibility to ensure that their online enrollment record with SD Medicaid reflects their current business operations including who is providing services and noting their current locations and licensure. All updates to a provider enrollment record are initiated by logging in to the online enrollment record. Utilize the training materials to assist in navigating the online enrollment system as well as the documents below which guide you through the most common provider record updates. Please print these off before you begin or refer back to them as necessary.

Remember to submit your changes.

  • Click on the last step of your enrollment record to find and click on the “Submit” button when you are done with each round of updates. 
  • If you are making updates to servicing individual records you need to click “Submit” for each individual’s record prior to clicking submit for the Group, FAOIP, or Tribal/IHS record.
  • Failure to click “submit” will result in the State not being aware of your desired changes.

Common Changes