Billing Agent - dss sd 2025

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Contact your medical provider or South Dakota Medicaid at 1.800. 597.1603. You can also view covered services in the Medicaid Recipient Handbook.
Although Amerigroup prefers the submission of claims electronically through the electronic data interchange (EDI), Amerigroup will accept paper claims.
Matt Althoff, secretary of the Department of Social Services, sat down with SDPBs Lee Strubinger for an in-depth conversation about South Dakota Medicaid.
To submit paper Institutional claims to South Dakota Medicaid, providers are required to use the official UB-04 (CMS-1450) claim form printed in red OCR ink and the claim must be typewritten. Information on the claim needs to be in exact fields and cannot crossover into incorrect fields.
Medicaid claims often require documentation showing that the service provided was medically necessary. If a claim doesnt demonstrate this needwhether due to poor documentation or the service not being covered under Medicaids medical necessity guidelinesit can lead to a denial.

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Adults, ages 19 to 64, meeting the income limits and other general eligibility requirements (with or without private health insurance) may be eligible for FREE or low-cost South Dakota Medicaid including regular checkups, dental care, and vision care.
The Administrative Simplification Compliance Act (ASCA) requires that Medicare claims be sent electronically unless certain exceptions are met. Providers meeting an ASCA exception may send their claims to Medicare on a paper claim form.

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