South Dakota Medicaid has made an update to billing requirements to always require the rendering (servicing) NPI and taxonomy for claims billed on a CMS 1500 claim form.

The South Dakota Department of Social Services has received questions and feedback about the requirement for electronic submissions when the rendering provider information is the same as the billing provider information. The requirement is consistent with the ANSI 5010 Guide that defines “Situational” data as an element or segment that is required when a payer’s adjudication is known to be impacted by that information.

The department uses the data in its matching process to identify providers correctly, and the rendering provider information is required for paper and electronic submissions. Billing requirements are outlined in the Professional Services Billing Manuals and DSS Companion Guide (837P) found online here.

For questions, please call (800) 452-7691 (in-state) or (605) 945-5006 (out-of-state).