A provider is eligible to receive payment for the full amount allowed under the department's payment schedule while the department pursues reimbursement from third-party sources in the following situations:

1. (1) The claim is for services for early and periodic screening, diagnosis, and treatment, provided under chapter 67:16:11, except for psychiatric inpatient services, nutritional therapy, nutritional supplements, and electrolyte replacements;
2. (2) The third-party liability is derived from an absent parent whose obligation to pay support is being enforced by the department and 100 days from the date of service have elapsed;
3. (3) The probable existence of third-party liability cannot be established at the time the claim is filed;
4. (4) The claim is for nursing facility services reimbursed under chapter 67:16:04; or
5. (5) The claim is for services provided by a school district under chapter 67:16:37.

Source: 16 SDR 226, effective June 24, 1990; 17 SDR 184, effective June 6, 1991; 31 SDR 39, effective September 29, 2004; 46 SDR 50, effective October 10, 2019; 47 SDR 38, effective October 6, 2020.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1 (2)(4) .

Prior versions effective: 2019-10-10, 2004-09-29.