Except for items dispensed under the provisions of subdivision 67:16:14:06.06(2) or § 67:16:14:06.09, claims for items provided under this chapter must be submitted at the provider's usual and customary charge.

A claim for items dispensed under subdivision 67:16:14:06.06(2) or § 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.

A provider may not submit a claim for items that have not been provided.

Source: 16 SDR 234, effective July 1, 1990; 17 SDR 4, effective July 16, 1990; 22 SDR 93, effective January 7, 1995.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.