SD Medicaid Reimbursement

SD Medicaid Reimbursement

South Dakota is fortunate to have fee-for-service Medicaid reimbursement for CHW/CHR services. The following pages provide an extensive overview, tools, and guides to assist organizations in enrolling in SD Medicaid as a CHW Agency, implementing workflows for CHW reimbursement, and successfully billing for CHW services.

Before reaching out to the CHWSD for individual questions or assistance, please review the following pages in their entirety, review the current version of the CHW Billing and Policy Manual, and review the FAQs at the bottom of this page.

Readiness Assessment

Before you begin the enrollment process, review and take the readiness assessment (as a printable PDF checklist) here:

Readiness Assessment

Enrollment

To enroll as a Community Health Worker (CHW) Agency with South Dakota Medicaid, you will need to follow the specific procedures and requirements outlined by the South Dakota Department of Social Services (DSS). Learn more about how to enroll as a CHW Agency with South Dakota Medicaid.
Enrollment

Implementation

Once you have been notified that your organization is an approved CHW Agency with South Dakota Medicaid, you can then begin the process of working with a provider to receive a referral and service plan for CHW services. Learn more about reviewing a patient’s Medicaid eligibility, what type of providers can refer, referrals, and service plans.
Implementation

Billing

Understanding Medicaid billing for CHWs is crucial for program sustainability. While some CHW programs may have access to a billing team and/or billing department, other programs may need to learn to bill Medicaid and submit claims for payment. The following provides helpful information about billing SD Medicaid for CHW services.

Billing
Frequently Asked Questions
Billing and Policy Manual