SD Medicaid Reimbursement FAQs
Frequently Asked Questions
Enrollment FAQs
Q. Where do I start?
A. If your organization plans to bill SD Medicaid for CHW services, please notify your CHWSD contact as soon as possible.
1- Obtain Type-2 NPI. Click here.
2- Submit the SD Medicaid enrollment application. Click here.
3- Complete required forms/documents including:
a. CHW Policies and Procedures (once Ashley Lauing at SD Medicaid approves these, she will tell you the effective date you can back bill to – corresponding to the date you submitted final versions of policies/procedures)
c. Disclosure
d. Bank Letter
e. CHW Addendum (NOTE: For the field requesting Application ID – disregard/leave blank)
4 – Certification – complete certification for all staff. For more certification information, click here.
Q. What is NPPES?
A. National Plan & Provider Enumeration System (NPPES)
To enroll as a CHW Agency with South Dakota Medicaid, organizations will need to register for an NPI Type 2 number through the National Plan & Provider Enumeration System (NPPES). Organizations should apply for this early in the enrollment process as it can take up to 6 weeks to obtain an NPI number. Register here.
Q. How do I find out who the Authorized Official is for my organization?
A. You can search for your organization’s information on the NPPES registry. This will show your NPI type, primary address, and primary taxonomy. Click on the NPI number and it will show more information, including when the number was established and the Authorized Official. Search here.
Q. What if the Authorized Official is no longer with my organization?
A. An authorized official is an appointed official with the legal authority to make changes and/or updates to the organization provider’s status (e.g., change of address, etc.) and to commit the organization provider to fully abide by the laws and regulations relating to the National Provider Identifier. The authorized official must be a general partner, chairman of the board, chief financial officer, chief executive officer, or direct owner of 5 percent or more of the organization provider being enumerated or must hold a position of similar status and authority within the organization.
Anyone that is a direct employee can apply to become an authorized official through NPPES. Click here. The signature of the currently authorized person is not required.
If you have any questions, please contact the External User Services (EUS) Help Desk:
External User Services (EUS) Help Desk, PO Box 792750, San Antonio, TX 78279
1-866-484-8049
[email protected]
Q. What information should be included on the bank letter we need to submit to Medicaid?
A. Upon initial entry and any subsequent changes, the enrolled entity will need to provide a letter from the financial institution that includes the name of the institution, the routing number, the account number, and the account type. Failure to populate the information correctly may result in payments not reaching the enrolled entity.
Q. What do we enter for License/Certification Type and Lic/Cert#?
A. In the SD Medicaid application, for License/Certification Type and Lic/Cert#, according to the Provider Enrollment Chart the fields should be populated with None and NA.
To view a sample, click here.
Q. What is the taxonomy code for Community Health Worker?
A.172V00000X
Q. Can we just add the CHW taxonomy code to an existing Type-2 NPI?
A. No. SD Medicaid requires a new, unique Type-2 NPI instead of adding the taxonomy to an existing one to keep the CHW agency separate.
Billing FAQs
Q. How many units should I bill to SD Medicaid?
A:
Minutes 0-15 = 0 units
Minutes 16-45 = 1 unit
Minutes 46-75 = 2 units
Minutes 76-105 = 3 units
Minutes 106+ = 4 units
The first 15 minutes of any unit are not billable so if you had a recipient that you met with for an hour and 5 minutes you can only bill 2 units as the next unit wouldn’t start until an hour and 16 minutes.