<html> <head> <title>Rule 67:16:14:13 Billing requirements.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:14:13"> <META NAME="Description" Content="Administrative Rules 67:16:14:13 Billing requirements."> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Originator content="Microsoft Word 10"> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:14:13.&nbsp;&nbsp;Billing requirements.</b> Except for items dispensed under the provisions of subdivision 67:16:14:06.06(2) or §&nbsp;67:16:14:06.09, claims for items provided under this chapter must be submitted at the provider's usual and customary charge.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A claim for items dispensed under subdivision 67:16:14:06.06(2) or §&nbsp;67:16:14:06.09 must be submitted at the provider's cost. To verify the charges, the provider must maintain a copy of the supplier's invoice showing the actual cost of the item to the provider and all discounts applied to the invoiced item. At the department's request, a provider must furnish information to substantiate a claim.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A provider may not submit a claim for items that have not been provided.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 16 SDR 234, effective July 1, 1990; 17 SDR 4, effective July 16, 1990; 22 SDR 93, effective January 7, 1995.</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A></font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A></font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-Reference:</b> Third-party liability, ch 67:16:26.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html>