MedicaidAdministrativeMedium impact
Urgent Care Visit Billing Instructions
South Dakota Medicaid·SD · Emergency Medicine, Family Medicine, General Practice·Claims & Billing
Effective date
May 28, 2025
We identified it
Jun 21, 2026
Summary
South Dakota Medicaid allows up to 4 urgent care visits per plan year (July 1 - June 30) without requiring referrals from care management providers. Specific billing instructions must be followed to ensure these visits are properly exempted from referral requirements.
Action Required
Immediately: Billing team must update urgent care claim submission procedures for South Dakota Medicaid patients enrolled in care management programs. For Portal submissions: select 'Urgent' in item 24c dropdown. For Electronic submissions: enter 'Y' in 24c (SV109) and use situational loop 2300 REF*4N*1. For Paper submissions: enter 'U' or '2' in Block 10d (or Block 19 if necessary). Use portal service limits function to track patient's urgent care visit count. Failure to follow these instructions may result in claim denials for exceeding the 4-visit annual limit.