CHAPTER 44:06:05
CLAIMS
Section
44:06:05:01 Billing procedures.
44:06:05:02 Third-party sources.
44:06:05:03 Maximum allowed for financial assistance.
44:06:05:01. Billing procedures. The CSHS program shall
pay the provider for authorized services rendered after receiving pertinent
billing information as follows:
(1) A completed
standardized billing form received within one year from the service date; and
(2) An insurance deduction
or rejection shown on the billing form with an attached explanation of benefits
from the insurance plan, or if a prescription drug claim, a completed CSHS
prescription drug claim form allowing the pharmacy to bill CSHS without an
explanation of benefits form.
Source:
6 SDR 93, effective July 1, 1980; 14 SDR 182, effective July 11, 1988; 20 SDR
91, effective December 19, 1993; 30 SDR 198, effective June 23, 2004; 33 SDR
106, effective December 26, 2006; 34 SDR 93, effective October 17, 2007.
General
Authority: SDCL 34-1-21.
Law
Implemented: SDCL 34-1-21.
44:06:05:02. Third-party sources. Claims for services payable by third-party sources must be initiated by providers. The CSHS program shall apply payments from third-party sources toward the cost of services rendered.
Source: 6 SDR 93, effective July 1, 1980; 20 SDR 91, effective December 19, 1993.
General Authority:SDCL 34-1-21.
Law Implemented:SDCL 34-1-21.
44:06:05:03. Maximum allowed for financial assistance. An
eligible client is allowed a maximum of $20,000 each state fiscal year for
preauthorized services related to the client's coverable chronic medical
condition.
Source:
6 SDR 93, effective July 1, 1980; 8 SDR 155, effective May 27, 1982; 9 SDR 162,
effective June 20, 1983; 14 SDR 182, effective July 11, 1988; 30 SDR 198,
effective June 23, 2004; 33 SDR 106, effective December 26, 2006.
General
Authority: SDCL 34-1-21.
Law
Implemented: SDCL 34-1-21.
