S.D. Admin. R. 67:16:26:07.01
Current through Register Vol. 51, page 57, November 12, 2024
If a recipient is eligible for Medicare, the provider must submit a completed claim for payment of services to the Medicare carrier or intermediary. The provider is eligible to receive payment from the department for the deductible and coinsurance as indicated on the explanation of benefits for those physician and outpatient services allowed by the Medicare carrier. Deductible and coinsurance payments for inpatient hospital services are subject to chapter 67:16:03.
The department may not pay for any service that has been denied by Medicare as not medically necessary or reasonable or as not meeting the requirements for submitting a claim.
S.D. Admin. R. 67:16:26:07.01
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.