SD continuing to process revalidation submissions requested of all Medicaid providers

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South Dakota is continuing to process the revalidation submissions requested of all Medicaid providers in the summer of 2016 in order to meet federal requirements. Given the large volume of applications to review and process, the revalidation process can take months to complete and approve.

Upon approval of a revalidation record, Department of Social Services (DSS) Provider Enrollment staff send an approval email to the listed enrollment contact. Providers who submitted the revalidation application and have claims that were not paid timely should include the approval email with each claim that the provider was unable to have processed that meets the conditions shown in the sample below. Please note that providers are not required to submit claims repeatedly in order to preserve timely filing.

The department is offering additional guidance:

  • If you are unsure if your record has been revalidated, please login to SD MEDX to check the status of your enrollment record.
  • If you or your entity have not received approval for revalidation actions requested in 2016 and you have had a change in payment details or EDI partners that require immediate updates, please contact Ellen Blauert or Patrick Cushing at (605) 773-3495. Other updates, e.g., changes to staffing, need to be made following the revalidation approval.
  • If your record is approved, but your enrollment contact isn’t in receipt of a revalidation approval message and need it for claims processing, please send the entity NPI to SDMEDXGeneral@state.sd.us and request that the revalidation approval be resent. Please note, this approval will be shared with the listed enrollment contact.

The approval notice, as show in the example below, includes the instructions for handling provider claims.

Example Language to Providers:
NPI: xxxxxxxxxx Name: Provider Name

The revalidation for the provider shown above has been approved along with any listed individuals noted below. You may now log into your SD MEDX record to update and maintain the provider information as necessary. If additional assistance is required, please email the SD Medicaid Provider Enrollment Response Team at sdmedxgeneral@state.sd.us or call 866-718-0084.

Servicing Provider Name Servicing Provider NPI Start Date End Date

We recognize that our extended processing time has the ability to impact claims filing in the event that:

  • An enrolled servicing provider was added to your servicing provider list step during revalidation in order to bill for professional services; or
  • An enrolled servicing provider joined your entity while your entity revalidation record is/was under review; or
  • An entity expanded services during revalidation which required DSS approval for billing.

If you have claims for dates of service 1/1/16 and after that no longer meet our timely filing requirements when your revalidation is approved that are directly impacted by DSS processing time as noted above, please do the following:

  • Identity all impacted claims due to DSS processing delay
  • Attach a copy of your entity’s revalidation approval email to each of those impacted paper claim forms
  • Send the packet of untimely claim forms separate from other claims to the attention of Ellen, DSS MS PE, 700 Governors Dr, Pierre, SD 57501within 30 days of your revalidation approval notice.