PDF
Word
Medicaid Credit Balance Report Form - South Dakota
Medicaid Credit Balance Report Form is a legal document that was released by the South Dakota Department of Social Services - a government authority operating within South Dakota.
FAQ
Q: What is the Medicaid Credit Balance Report Form?A: The Medicaid Credit Balance Report Form is a document used in South Dakota to report any overpaid credits to Medicaid providers.
Q: Who is required to complete the Medicaid Credit Balance Report Form?A: Medicaid providers who have received overpaid credits are required to complete the form.
Q: How often should the Medicaid Credit Balance Report Form be submitted?A: The form should be submitted annually, within 120 days of the provider's fiscal year-end.
Q: What information is required to complete the Medicaid Credit Balance Report Form?A: The form requires information such as provider name, provider number, Medicare number, and detailed credits for each individual resident.
Form Details:
- Released on August 1, 2018;
- The latest edition currently provided by the South Dakota Department of Social Services;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of the form by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the South Dakota Department of Social Services.
Download Medicaid Credit Balance Report Form - South Dakota
1
2
