MedicaidAdministrativeHigh impact
Claims Work Queue Inpatient Hospitals
South Dakota Medicaid·SD·Provider Communication
We identified it
Sep 12, 2026
Summary
South Dakota Medicaid now requires inpatient hospital claims for Care Management program recipients to include the referring provider's NPI in claim locators 78 or 79. A new Claims Work Queue portal feature allows providers to submit missing NPI information within 30 days without resubmitting the entire claim; claims without the referral NPI after 30 days will be denied.
Action Required
Immediately: Billing team must verify that all inpatient hospital claims for SD Medicaid Care Management recipients include the referring provider's NPI in claim locators 78 or 79 before submission. Update claim submission procedures and staff training to ensure compliance. Within 30 days of claim pend notification: Monitor the SD Medicaid Portal Claims Work Queue for pended inpatient claims and submit the referring provider's NPI and supporting referral documentation to avoid automatic denial after the 30-day window. Set up internal tracking system to alert staff of the 30-day deadline for each pended claim. Failure to include the referring NPI will result in claim denial for PCP/HH/NPI incorrect.