Credentialing in South Dakota

SD Medicaid (Department of Social Services) enrolls all providers through the online Provider Enrollment (PE) Portal. All enrollment activity has been electronic since 5/5/2021, with supporting documents emailed to SDMedicaidPE@state.sd.us. "No application fee is charged." Structure: BNPI for Type-2 organizations and solo SSN-billers, SNPI for Type-1 individuals rendering through a BNPI; ordering/referring/attending providers get simplified enrollment on claim submission.

SD DSS, Medicaid Provider Enrollment & Maintenance · checked Jul 2026

South Dakota has no Medicaid MCOs, all claims are fee-for-service to the state, so there are no MCO panels to join. What SD has instead: PRIME, a primary-care case management (PCCM) program in which roughly 80% of consumers "are required to enroll in the program and choose one primary care provider", PCPs are reimbursed "under the usual fee-for-service system" plus "a monthly case management fee of $3.00 per member per month", plus Health Homes care coordination. PRIME members need PCP-directed referrals for specialty services.

SD DSS, Access Monitoring Review Plan 2020 · checked Jul 2026

SD Medicaid's Independent Mental Health Practitioners manual lets the mid/supervision tier enroll: eligible providers include the "Certified Social Worker - PIP candidate" and the "Licensed Professional Counselor working toward a Mental Health designation," alongside CSW-PIP, CNS, LMFT, LPC-MH, and Licensed Psychologists. The mechanic is explicit: a mental health provider "must have an individual National Provider Identification (NPI) number and may not provide services under another provider's or an employer's NPI number." The lone exception: psychological/neuropsychological test administration by a technician "must be billed under the supervising provider's NPI number."

SD Medicaid Billing and Policy Manual, Independent Mental Health Practitioners (June 2026) · checked Jul 2026

All four SD behavioral-health boards sit under the Department of Social Services: the Board of Examiners for Counselors & Marriage and Family Therapists (LPC then LPC-MH; LMFT), the Board of Social Work Examiners (CSW then CSW-PIP), the Board of Examiners of Psychologists, and the Board of Addiction and Prevention Professionals.

SD DSS, Board of Examiners for Counselors & Marriage and Family Therapists · checked Jul 2026

South Dakota is a Counseling Compact member (on the counselingcompact.gov jurisdictions list) but was not issuing as of July 2026.

Counseling Compact, Compact Jurisdictions · checked Jul 2026

"Enrollment records and documentation must be completed and received within 30 days of starting data capture, or it will be denied/rejected." Stage the document pack (provider agreement, disclosure, license copies, bank letter for BNPI) before opening the portal record, or you restart at day 30.

SD DSS, Medicaid Provider Enrollment & Maintenance · checked Jul 2026

Enrolled providers who are eligible for Original Medicare must enroll in Original Medicare, or SD Medicaid will not pay on dual-eligible members.

SD Medicaid, General Coverage Principles manual (June 2026) · checked Jul 2026

Out-of-state providers must submit a claim meeting prior-authorization and timely-filing requirements WITH the enrollment documentation to be deemed eligible. DSS advises completing enrollment actions at least 45 days before timely-filing deadlines; state-caused delays can earn a filing extension noted in the approval.

SD DSS, Medicaid Provider Enrollment & Maintenance · checked Jul 2026

SD Medicaid caps psychotherapy at 40 hours per state fiscal year.

SD Medicaid Billing and Policy Manual, Independent Mental Health Practitioners (June 2026) · checked Jul 2026