A claim for services provided under this chapter must be submitted on a form which contains the following information:
A separate claim form must be used for each recipient.
S.D. Admin. R. 67:54:07:16
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
Note: The HCFA 1500 form substantially meets the requirements of this rule and its content and appearance are acceptable to the department. These forms are available for direct purchase through the Superintendent of Documents, U. S. Government Printing Office, Washington D.C. 20402. (202) 783-3238 - pricing desk.
Claims, ch 67:16:35.