Laurie Gill
Cabinet Secretary

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Provider Enrollment: New Providers

SD Medicaid uses an online enrollment application process with required supporting documentation sent via email. Applications must be completed and supporting documentation must be received within 30 days of the application start date or the application will be denied/rejected. After that time the provider will be required to begin the application process over. There is currently no application fee charged.

Eligibility Criteria:

  • Providers must be a type of provider recognized by SD Medicaid and meet requirements noted on our provider enrollment chart.
  • Out-of-state providers must submit a claim for services that meets prior authorization and timely filing requirements as part of the enrollment documentation to be deemed eligible.
    • Please refer to South Dakota Administrative Rule 67:16:35:04 for specific details on timely filing. Most claims must be submitted within six months from the date of services.
    • Timely filing requirements cannot be extended for failure to obtain prior authorization, provide documentation, or complete the online application within the timely filing period.

Provider Application Types

South Dakota Medicaid has five types of online application forms. With the exception of billing agents, all applications require a valid NPI. Please review the following application types below to determine your appropriate online enrollment process and start the application.

To determine what information will be required on the application, refer to the corresponding Quick Reference


Guide

  • Billing Agents Start Online Billing Agent Application
  • Group Provider
      • A Group provider is an organization of individual providers that provide medical or dental services. A Group provider has a Type 2 NPI and rendering/servicing providers with a Type 1 NPI must be associated to the Group provider.
      • New servicing providers not known to SD MEDX at the time of the group application should have the individual application started from within the group record under the servicing provider step.
      • Training Information:
      • Required Paperwork:
    Start Online Group Application
  • Facility/Agency/Organization/Institution/Pharmacy (FAOIP)
  • Tribal or Indian Health Services Provider
  • Individual Providers
    • Servicing Individual Providers
      • A Servicing Individual is a provider who provides services through a Group, Facility, Agency, Organization, Institution, Pharmacy, Tribe, Indian Health Services or Regular Individual Provider. A servicing provider does not bill directly to South Dakota Medicaid. A Billing Provider that is associated to the individual submits claims and receives payments for the servicing provider. Payments are reported under the Billing Provider’s FEIN, not the individual’s SSN. If the Billing Provider is not approved in SD MEDX prior to starting the individual application, make sure the individual application is started from within the entity application.
        • Start Online Individual Provider Applications
        • Training Information
        • Required Paperwork:
          • Provider Agreement
          • 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.
    • Regular Individual Providers
      A Regular Individual Provider is a provider that owns his/her own practice that is not incorporated. This provider will receive payments directly from SD Medicaid for services rendered at their practice which is required to be reported under the provider's SSN. A provider who desires to have payments reported under a FEIN or TIN must obtain a Type 2 NPI and enroll as a Group and Servicing Individual Provider. A Regular Individual Provider may associate to other entities while Servicing Individual providers may associate to other entities and Regular Individual Providers.

Questions? Contact us at sdmedxgeneral@state.sd.us or call
1-866-718-0084

Please include your NPI in your email or have your NPI available when you call.