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.

Source: 2 SDR 16, effective September 4, 1975; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 9 SDR 11, effective August 1, 1982; transferred from § 67:16:01:21, 16 SDR 226, effective June 24, 1990; 17 SDR 194, effective June 24, 1991.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.