South DakotaHealth carriers face an 18-month limit to recover medical claims
For medical services provided on or after July 1, 2026, health carriers generally have 18 months to seek repayment and must explain the reason in writing.
What it does
For covered medical claims, health carriers may recover or deny a payment only within 18 months and after giving the provider written notice of the reason. Several types of claims are exempt.
When a provider repays a claim under this rule, the carrier may collect only the original payment, with no added fees, penalties, or interest.
Argument forProviders may face fewer late repayment demands and would not owe extra fees, penalties, or interest when repaying a covered claim.
Argument againstCarriers could lose the chance to recover some mistaken payments found more than 18 months later, unless an exception applies.
More detail
A health carrier may recover or retroactively deny a paid claim only within 18 months after payment, and must give the provider written notice of the reason. The rule covers claims for medical services, but not dental services, pharmaceutical services, or prescription drugs or supplies. Exceptions cover claims the carrier determines involve fraud, waste, or abuse; certain adjustments by unrelated payors; and claims covered by specified insurance, health plans, or federal laws, including Medicare and Medicaid. The limit also does not apply when the provider or member was already paid for the same services. The rule applies to claims for medical services provided on or after July 1, 2026.
A provider repaying a claim under this section must return only the amount the carrier originally paid. This applies when a provider repays a health carrier under the claim recovery rule. The repayment may not include added fees, penalties, or interest. The rule applies to claims for medical services provided on or after July 1, 2026.
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Where it stands
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Mar 30Signed by the Governor Larry Rhoden on 2026-03-30 H.J. 579Became Law
- Mar 10Delivered to the Governor on 2026-03-10 H.J. 546To Governor
- Mar 9Signed by the President S.J. 506Passed Senate
- Mar 5Signed by the Speaker H.J. 529Passed House
- Mar 4Senate Do Pass Amended , Passed, YEAS 34, NAYS 0 S.J. 461
- Mar 2Certified uncontested, placed on consent , Passed, S.J. 25
- Vote recorded Do Pass. Result: pass.Upper
- Mar 2Health and Human Services Do Pass , Passed, YEAS 7, NAYS 0 S.J. 25Minor
- Mar 2Scheduled for hearing
- Feb 23First read in Senate and referred to Senate Health and Human Services S.J. 357Minor
- Feb 20House of Representatives Do Pass Amended , Passed, YEAS 67, NAYS 0 H.J. 390
- Vote recorded Do Pass Amended. Result: pass.Lower
- Feb 18Commerce and Energy Do Pass Amended , Passed, YEAS 12, NAYS 1
- Vote recorded Do Pass Amended. Result: pass.Lower
- Feb 18Commerce and Energy Motion to amend , Passed, Amendment 1292BMajor
- Feb 18Scheduled for hearing
- Feb 4First read in House and referred to House Commerce and Energy H.J. 218Introduced
Healthcare