Rule 67:16:35:04 Time limits for submission of claims.
limits for submission of claims. The department must receive a provider's
completed claim form within six months following the month the service was
provided. This time limit may be waived
or extended only if one or more of the following situations exist:
(1) The claim is an
adjustment or void of a previously paid claim and is received within three
months after the previously paid claim;
(2) The claim is received
within six months after a retroactive initial eligibility determination was
made as a result of an appeal;
(3) The claim is received
within three months after a previously denied claim;
(4) The claim is received
within six months after the provider receives payment from Medicare or private
health insurance or receives a notice of denial from Medicare or private health
(5) To correct an error
made by the department.
SL 1975, ch 16, § 1; 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7
SDR 89, effective July 1, 1981; 15 SDR 2, effective July 17, 1988; transferred
from § 67:16:01:14, 17 SDR 4, effective July 16, 1990; 19 SDR 26,
effective August 23, 1992; 37 SDR 53, effective September 23, 2010.
Authority: SDCL 28-6-1.
Implemented: SDCL 28-6-1.
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