SD Medicaid Enrollment

SD Medicaid General Information

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CHW Checklist

This document summarizes the step-by-step process an organization must complete to become an enrolled CHW agency through South Dakota Medicaid.

CHW Checklist
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Medicaid Fee Schedule

The following link provides the fee schedule for CHW services offered both individually and in a group setting.
Medicaid Fee Schedule
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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

Type-2 NPI

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Type-2 Enrollment

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. Organizations should apply for this early on in the enrollment process as it can take up to 6 weeks to obtain an NPI number.
Type-2 Enrollment
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Type-2 Enrollment Form

The following form can be used as a draft for organizations to use to ensure the appropriate information is prepared before completing the NPI enrollment online. Please Note: CHW organizations need to enroll to obtain a new and unique Type 2 NPI number. CHW organizations should ONLY use the taxonomy code: 172V00000X for this new Type 2 NPI number specific to their CHW program. Please Note: As you select the CHW Taxonomy code of 172V00000X, the Multi-Specialty Group Code or the Single-Specialty Group Code of 193200000X may also show under your NPI number specific to your CHW program. The CHW taxonomy code should always be primary.

Type-2 Enrollment Form

SD Medicaid Enrollment

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Provider Enrollment

SD Medicaid has an online enrollment process for providers/agencies meeting the eligibility criteria who are providing eligible services. Organizations enrolling as a CHW Agency will need to complete provider enrollment as part of the enrollment process.
Provider Enrollment
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SD Provider Enrollment Portal User Guide

The South Dakota Medicaid Provider Enrollment Portal (PE Portal) was designed to increase a provider’s ability to self-control who has access to its data. The PE Portal is the entry point for an eligible provider to enroll as a SD Medicaid provider. It is also the entry point and system of record for enrolled providers to update and maintain their enrollment records.
SD Provider Enrollment Portal User Guide

Templates and Supporting Documents

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Policies & Procedures

To assist organizations in applying to become a CHW Agency, the CHWSD has worked with SD Medicaid to develop a CHW Policies and Procedures Checklist as well as provide a sample draft of each required policy.
CHW Policies and Procedures
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Other Documents

Below are other documents to complete during the application process.
– 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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Medicaid Reimbursement

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