MedicaidAdministrativeHigh impact
HMS Disallowance and Recoupment Process
South Dakota Medicaid·SD·Provider Communication
Effective date
Aug 1, 2026
We identified it
Jul 28, 2026
Summary
South Dakota Medicaid has partnered with Health Management Systems (HMS) to conduct third-party liability and coordination of benefits reviews starting August 2026. Providers must respond to HMS claims review notices within 60 days via their online portal, or claims will be automatically recouped. Failure to register and respond will result in financial recoupment by DSS.
Action Required
REQUIREMENTS:
By August 2026 (start of first review cycle): (1) Billing/compliance team must register for HMS portal access at https://ecenter.hmsy.com/external/SelfRegister.jsp if not already registered. (2) Designate staff member(s) responsible for monitoring HMS communications and portal submissions. (3) Establish internal workflow to track HMS review notices and response deadlines.
Within 60 days of receiving HMS claims review communications: (1) Billing team must review all identified claims in HMS portal at https://hmsportal.hms.com. (2) Verify whether third-party insurance was actually primary for flagged claims. (3) Submit detailed responses directly to HMS portal with supporting documentation (EOBs, insurance verification, etc.). (4) Do NOT wait for the 60-day deadline—respond promptly to avoid automatic recoupment authorization.
Consequences of inaction: Failure to respond within 60 days constitutes acceptance of HMS findings and authorization for DSS to recoup all disallowed claim payments directly from provider accounts. This will result in unexpected financial losses and cash flow disruption.
For questions or disputes: Contact HMS Third Party Liability Service Center at 833-950-7300 or 877-256-1226 (fax), or contact South Dakota Medicaid ORFI at recoveries@state.sd.us or 605-773-3653.