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          67:16:35:01.  Definitions. Terms used in this chapter mean:

 

          (1)  "Adjustment/void claim form," a form that is used to adjust or void a previously paid claim;

 

          (2)  "Cross-over claim form," a form used to record the Medicare co-insurance and deductible payments for recipients who are eligible for both Medicare and Medicaid;

 

          (3)  "Denied claim," a claim that does not qualify for a medical assistance payment;

 

          (4)  "Pended claim," a claim which has not been paid or denied but is being reviewed for final action; and

 

          (5)  "Remittance advice," a document sent to the provider which contains the status of claims submitted by that provider.

 

          Source: 17 SDR 4, effective July 16, 1990; 17 SDR 184, effective June 6, 1991; 26 SDR 168, effective July 1, 2000.

          General Authority: SDCL 28-6-1.

          Law Implemented: SDCL 28-6-1.

 


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