<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><meta http-equiv='content-language' content='en-us'/><title>SDLRC - Codified Law 58-17-149 - Definitions regarding retrospective payment of clean claims for covered services provided during credentialing period. </title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.s2075073Normal { text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } span.s2075073SENU { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s2075073CL { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } p.s2075073Normal-000000 { text-indent: 0.50in; text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-left: 0; margin-right: 0; margin-bottom: .001pt; } span.s2075073DefaultParagraphFont { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } p.s2075073Normal-000001 { margin-left: 0.70in; text-indent: -0.45in; text-align: justify; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; margin-top: 0; margin-right: 0; margin-bottom: .001pt; } span.s2075073000002 { font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s2075073SCL { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s2075073SCL-000003 { font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } body { text-decoration-skip-ink: none; } </style></head><body><div><p dir="ltr" class="s2075073Normal"><a href="https://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=Statute&amp;Statute=58-17-149"><span class="s2075073SENU">58-17-149</span></a><span xml:space="preserve" class="s2075073SENU">. </span><span class="s2075073CL">Definitions regarding retrospective payment of clean claims for covered services provided during credentialing period.</span></p><p dir="ltr" class="s2075073Normal-000000"><span xml:space="preserve" class="s2075073DefaultParagraphFont">Terms used in §§ </span><a href="https://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=Statute&amp;Statute=58-17-149"><span class="s2075073DefaultParagraphFont">58-17-149</span></a><span xml:space="preserve" class="s2075073DefaultParagraphFont"> to </span><a href="https://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=Statute&amp;Statute=58-17-152"><span class="s2075073DefaultParagraphFont">58-17-152</span></a><span class="s2075073DefaultParagraphFont">, inclusive, mean:</span></p><p dir="ltr" class="s2075073Normal-000001"><span class="s2075073DefaultParagraphFont">(1)    "Application date," the date on which a health insurer or other entity responsible for the credentialing of health care professionals on behalf of the health insurer receives the health care professional's completed application for credentialing or change request;</span></p><p dir="ltr" class="s2075073Normal-000001"><span xml:space="preserve" class="s2075073DefaultParagraphFont">(2)    "Clean claim," as defined in § </span><a href="https://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=Statute&amp;Statute=58-12-19"><span class="s2075073DefaultParagraphFont">58-12-19</span></a><span class="s2075073DefaultParagraphFont">;</span></p><p dir="ltr" class="s2075073Normal-000001"><span class="s2075073DefaultParagraphFont">(3)    "Health care professional," as defined in subdivision 58-17F-1(8);</span></p><p dir="ltr" class="s2075073Normal-000001"><span class="s2075073DefaultParagraphFont">(4)    "Health insurer," as defined in subdivision 58-17-100(2);</span></p><p dir="ltr" class="s2075073Normal-000001"><span class="s2075073DefaultParagraphFont">(5)    "Special Review," a supplemental review of a health care professional's completed application for credentialing or change request by a health insurer or other entity responsible for credentialing of health care professionals necessitated by credible evidence received by a health insurer or other entity responsible for credentialing of health care professionals as it relates to investigation of the following: action taken against the applicant's licensure status, action taken against the applicant's professional society status, verified complaints to facilities, or licensing agency regarding the applicant; the applicant's non-completion of training programs; a criminal proceeding brought against the applicant a malpractice claim brought against the applicant; loss of a Drug Enforcement Administration certificate or state-controlled substance certificate; loss of a Medicare or Medicaid certification status; or involuntary termination of credentialing by a different health insurer.</span></p><p dir="ltr" class="s2075073Normal"><span xml:space="preserve" class="s2075073000002"> </span></p><p dir="ltr" class="s2075073Normal"><span class="s2075073SCL">Source:</span><span xml:space="preserve" class="s2075073SCL-000003"> SL 2014, ch 236, § 1.</span></p></div></body></html>