Title: Department of Social Services
Headings: Frequently Asked Questions
Frequently Asked Questions
Recipient Frequently Asked Questions
What is South Dakota Medicaid?
Am I eligible for Medicaid?
What do I do if my name is spelled incorrectly or the date of birth is wrong on my Medicaid ID card?
How do I know what services are covered by Medicaid?
Are check-ups/preventative care covered by Medicaid?
Can I go to the Emergency Room (ER)?
Does Medicaid cover dental services?
Do I need a Primary Care Provider (PCP)?
How do I select a PCP?
When should I make an appointment with my PCP?
Can I change my PCP?
I forgot the name of my PCP. What do I need to do now?
Do I need a referral to see a provider other than my PCP?
Is a paper referral card required to see a provider other than my PCP?
Will Medicaid cover out-of-state services?
I have Medicaid. Why am I still getting a bill?
I have pregnancy only coverage. What does Medicaid cover?
How do I add my newborn child to my caseload?
Can I be reimbursed for travel to an appointment out of town?
How can I find a Medicaid dental provider?
My provider told me I have another type of medical insurance other than Medicaid. I DO NOT have any other insurance. What do I do?
Will my child be covered this summer when he/she goes to stay with his/her mother/father?
How do I obtain a certificate of coverage for my new insurance?
Are broken, lost, or stolen eyeglasses covered?
Does SD Medicaid pay for contact lenses?
Will my child's sports physical be covered by South Dakota Medicaid
What do I do if my prescription is NOT covered?
Non-Emergency Medical Travel Frequently Asked Questions
What can I be reimbursed for?
How do I know if I qualify for NEMT reimbursement?
If I have a medical appointment within the city I live, can i get reimbursed?
Can I get reimbursed to travel to my Primary Care Provider (PCP) or health Home Provider (HHP)?
If my PCP or HHP refers me to a medical specialty provider, do I need a copy of my referral card?
What do I need to do to get travel reimbursement to and from my medical appointment?
If I have already completed the NEMT Payment Authorization form, do I need to complete the form again?
If I had to stay overnight due to my medical appointment, do you need a copy of my motel receipt?
When will I receive my reimbursement?
How or where can I get the Medicaid Non-Emergency Medical Travel Form?
After my appointment I realized that I forgot to have the medical provider sign the reimbursement form verifying my appointment, what can I do?
Will I be reimbursed for meals for a same day medical trip?
Can I get reimbursed to travel to medical appointments out-of-state?
Can lodging be paid by NEMT if one parent/guardian/escort stays in the hospital and the other parent/guardian/escort stays in a hotel room?
I have a hotel room booked and I do not want to lose my room but have to return home over the weekend. Can I keep my belongings in the room and still be reimbursed by NEMT?
Provider Frequently Asked Questions
How do I know which services require a prior authorization?
What if I am not an enrolled South Dakota Medicaid provider?
Where can I find a paper enrollment application?
How long does it take to process new applications or updates to my record?
Do I have to enroll individual providers?
How long does my enrollment last?
How can providers receive Remittance Advices (RA's)?
Where do I find an excluded provider list?
Health Homes
What is a Health Home?
Why did South Dakota implement Health Homes?
Who is eligible for Health Homes?
What do providers need to do to become a Health Home Provider?
Who provides Health Home Services?
Where are Health Homes located?
How are providers reimbursed for Health Home Services?
Inpatient Hospitalization 6-Day Notification Form Frequently Asked Questions
Which hospitals are required to submit day six notification forms?
Is the notification form required for inpatient cases where South Dakota Medicaid is the secondary or tertiary payer?
Is notification required for all Medicaid programs regardless of the type of Medicaid assistance that recipient is receiving, i.e. QMB, Home Care Waiver, SSI Medicaid, Long Term Care, Assisted Living Waiver, CHIP?
Is the notification form required for inpatient hospital stays involving patients with pending South Dakota Medicaid applications (including inmates)?
Do we need to report inpatient hospitalizations if Medicaid eligibility determination is made retro‐actively?
Why are hospitals being required to submit notification for extended acute inpatient stays?
How will this length of stay information be used? When will hospitals receive calls from a DSS nurse?
Where is the form located? How do I submit the form?
If I submit the form online will that form be available to submit the discharge date or will I have to resubmit a new form?
Does the day of admission count towards the six days for reporting purposes?
If the notification form is submitted online on day seven or later, will the inpatient hospital claim be denied? Will appeals be considered?
Will I receive a confirmation number after I electronically submit the form so I know it was received?
When is the discharge form required to be submitted?
Will the program be staffed on weekends and holidays? Is this something that can wait until Monday or after the holiday for both the initial reporting and the discharge forms?
Do observations days (OBV) count toward the six inpatient days?
If the inpatient stay is for a DRG‐exempt unit (Neo‐natal intensive care unit, rehabilitation, and psychiatric) unit, do I have to report the stay?

Content: Delta Dental of South Dakota can also tell you if the $1,000 yearly limit has been or will be reached. Call Delta Dental of South Dakota at 800.627.3961 if you have questions about pre-approval, payment or the $1,000 limit. Do I need a Primary Care Provider (PCP)? A PCP is a provider or clinic you see for most of your medical care. Recipients eligible for the following programs must participate in the Primary Care Provider Program: Supplemental Security Income (SSI) recipients: blind, disabled people age 19 and older
Parent and other caretaker relatives
Children on Medicaid or Children’s Health Insurance Program (CHIP)
Pregnant Women
How do I select a PCP? If you are required to participate in the Primary Care Provider Program, you will receive a letter shortly after you are approved for South Dakota Medicaid with instructions on how to choose your PCP. Choose your PCP online with our Online Provider Selection Tool. If you are required to participate in the Primary Care Provider Program and you do not choose a PCP, DSS will choose one for you.