SD Medicaid Enrollment

Guidance provided below is meant to assist organizations and does not supersede guidance issued by either SD Medicaid or the Centers for Medicare and Medicaid Services (CMS). Please also review the SD Medicaid CHW Billing and Policy Manual in full before reviewing the information below. The Billing and Policy Manual can be found here.

Billing and Policy Manual

General Enrollment Information

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Billing and Policy Manual

Medicaid’s Billing and Policy Manual provides a comprehensive overview of CHW reimbursement including scope of work, reimbursement rates, limitations, etc. To access this manual, click the button below, scroll down to Professional Provider Manuals and click Community Health Worker Services.
Billing and Policy Manual
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SD Medicaid CHW Enrollment Checklist

This checklist is provided by SD Medicaid to assist CHW and CHR programs in navigating the steps for enrollment as a Medicaid Agency. This enrollment checklist can be printed and used throughout the enrollment process.

SD Medicaid CHW Enrollment Checklist

Applying for a New Type 2 NPI

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Type 2 Enrollment

To enroll as a CHW Agency with SD Medicaid, organizations will need to register for a NEW Type 2 NPI number through the National Plan & Provider Enumeration System. Organizations must apply for a NEW Type 2 NPI number to be used solely for CHW billing.

Note: DO NOT use an NPI number that was previously established. CHW Agencies using a previously used or even created Type 2 NPI number will not have success in enrolling with SD Medicaid and will need to start over to obtain a NEW NPI number used SOLEY for CHW Agency billing purposes. There are no penalties or concerns if an organization has multiple NPI numbers, therefor, a NEW Type 2 NPI number is the ONLY first step in enrolling with SD Medicaid as a CHW Agency.

Type 2 NPI Application Link
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Type 2 Application Guide

The following is a guide developed by the CHWSD for organizations to use to apply for a NEW Type 2 NPI.

Please review the guide in its entirety before beginning the application.

Type 2 Application Guide

SD Medicaid Enrollment

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SD Medicaid Provider Enrollment

Once a NEW Type 2 NPI has been obtained, the NEW NPI will need to be registered with SD Medicaid. SD Medicaid has an online enrollment process for providers/agencies.*

SD Medicaid Provider Enrollment Link

*If additional Billing NPI(s) access is required after initial registration approval and account creation, the user must email SDMedicaidPE@state.sd.us with the subject “Additional BNPI” and request that an additional BNPI be added to their account. This includes BNPIs that need to enroll.

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SD Medicaid Provider Enrollment User Guide

The following is a guide developed by SD Medicaid to assist organizations in navigating and completing the Provider Enrollment application.

SD Medicaid Provider Enrollment User Guide
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SD Medicaid Provider Enrollment Contact Information

SDMedicaidPE@state.sd.us.

866.718.0084

Templates and Supporting Documents

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Required Policies and Procedures

Organizations enrolling as a CHW Agency MUST submit required policies and procedures as part of the enrollment process.

Click the link below to view a detailed overview of the required policies and procedures as well as a step-by-step guide to finalizing and submitting the policies and procedures.

Draft Policies and Procedures
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Additional Required Documents

Below are additional documents that must be completed and submitted to SDMedXGeneral@State.SD.US along with the completed policies and procedures.

– PROVIDER AGREEMENT
Provider Agreement
– DISCLOSURE
Disclosure
– BANK LETTER
NOTE: Include name of institution, routing number, account number, and account type.
– CHW Addendum
CHW Addendum
NOTE: For the field requesting Application ID – disregard/leave blank.
– CURRENT 638 CONTRACT (for non-IHS tribal providers)

Certification

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Certification Requirements for CHWs and CHRs

CHWs and CHRs working for organizations seeking Medicaid reimbursement must be certified before providing services for reimbursement. Click below for more information on CHW/CHR certification.

CHW/CHR Certification
Frequently Asked Questions