Can Medicare Revoke a Practice’s Enrollment Over Denied Claims Under the New 2027 Rule?
CMS removed the factors it once weighed before revoking providers for a pattern of noncompliant claims, made revocations retroactive and cut the
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South Dakota Medicaid
South Dakota Medicaid, enrolled and paid
An active South Dakota Medicaid ID, records kept current, and claims that are not denied for enrollment.
South Dakota Medicaid said in spring 2026 that it was terminating long inactive providers, screening all providers monthly and building a new enrollment system called SD PECS, where providers will complete revalidation at go live. It denies claims for services by a provider who is not enrolled. The Department of Social Services explains enrollment on its Medicaid provider enrollment page.
Revalidation, spring 2026
As of spring 2026, South Dakota listed terminating providers inactive 24 months or longer, screening monthly and comparing records with Medicare, after CMS required a two year strategy. South Dakota Medicaid Provider News, Spring 2026
New enrollment tool
SD PECS, with revalidation completed in it at go live, anticipated for the end of 2026 or early 2027 as of spring 2026 (confirm the current date). South Dakota Medicaid Provider News, Spring 2026
Completion window and fee
Records and documents must be completed and received within 30 days of starting data capture or they are denied or rejected; no application fee. South Dakota Medicaid provider enrollment
Provider not enrolled
Claims for services rendered by a provider not enrolled with South Dakota Medicaid are denied. South Dakota Medicaid Provider News, Fall 2025
Filing after approval, 2023 notice
Since February 6, 2023 the extension is 30 days from the approval notice, with a copy of the notice attached to each late claim. Updated Provider Enrollment Claim Submission Extension, February 8, 2023
Medicare enrollment
Providers eligible for Original Medicare must be enrolled in it, or services for dually eligible recipients are not reimbursed. South Dakota Medicaid Provider News, Winter 2026
What we see in practice
45 to 90 days from submission to an active Medicaid ID.
In the official words
Claims submitted for services rendered by a provider not enrolled with South Dakota Medicaid will be denied.
Enrollment records and documentation must be completed and received within 30 days of starting data capture, or it will be denied/rejected.
South Dakota is screening and terminating providers ahead of a new enrollment process
CMS required every state Medicaid agency to submit a two year provider revalidation strategy, and South Dakota Medicaid says it was already acting before that notice. South Dakota Medicaid Provider News, Spring 2026 The state lists terminating providers who have been inactive for 24 months or longer, screening every provider each month against the federally required screening sources, and comparing provider data with Medicare enrollment to deem providers revalidated where it can. South Dakota Medicaid Provider News, Spring 2026
Any provider that no longer meets the conditions of participation has its Medicaid enrollment terminated. South Dakota Medicaid Provider News, Spring 2026 Where the state needs more from a provider, its enrollment team reaches out by email first, followed by a phone call if there is no response to the email. South Dakota Medicaid Provider News, Spring 2026 The newsletter asks providers to log in to their enrollment record and keep it up to date while this work continues. South Dakota Medicaid Provider News, Spring 2026
South Dakota Medicaid is also building a new enrollment system called SD PECS, and providers will be required to complete revalidation activities in it once it goes live. South Dakota Medicaid Provider News, Spring 2026 The spring 2026 newsletter said the go live date had not been set and was anticipated for the end of 2026 or early 2027, so confirm the current date with South Dakota Medicaid. South Dakota Medicaid Provider News, Spring 2026
Federal rules set the floor: a state must revalidate every provider at least every five years. 42 CFR 455.414
How enrollment works, step by step
- Register from the billing NPI. Access is authorized for billing NPIs only, and the first registration must come from a provider staff member, not an external credentialing entity. South Dakota Medicaid provider enrollment The 2021 bulletin adds that shared emails are not permitted and that the provider organization, not an external credentialing or billing entity, should register first. Provider Enrollment bulletin, May 6, 2021
- Start the record online and email the documents. Name the NPI and provider in the email, and say whether the enrollment is new or existing. South Dakota Medicaid provider enrollment
- Finish inside 30 days. Records and documents must be completed and received within 30 days of starting data capture, or the record is denied or rejected. South Dakota Medicaid provider enrollment
- Match the entity to its tax identifier. An organization's NPI requires a FEIN tied to the legal business name, and a group chooses a group taxonomy. South Dakota Medicaid provider enrollment
- An individual provider uses one taxonomy code unless the state notes otherwise. South Dakota Medicaid provider enrollment
- Update the record after any change of servicing address or clinic location, even a move within one healthcare system. South Dakota Medicaid Provider News, Fall 2025
- Do not budget for a fee. South Dakota charges no application fee. South Dakota Medicaid provider enrollment
South Dakota says enrollment records are generally reviewed in the order received. South Dakota Medicaid provider enrollment It tells providers to finish their actions at least 45 days before a timely filing deadline. South Dakota Medicaid provider enrollment We plan on 45 to 90 days from submission to an active Medicaid ID for a South Dakota provider.
Who has to enroll in South Dakota, and who does not
Billing and servicing providers must be a type South Dakota Medicaid recognizes on its provider enrollment chart and must provide covered services. South Dakota Medicaid provider enrollment In most situations the provider rendering a service and the provider billing for it must each have completed an online enrollment application. South Dakota Medicaid Referrals manual
Where an attending, ordering, referring or prescribing provider is not seeking direct reimbursement, South Dakota has a streamlined enrollment process that generally requires no action outside claim submission. South Dakota Medicaid Referrals manual Many such providers are covered by it on claim submission and are not required to take enrollment action. South Dakota Medicaid provider enrollment
A service performed by an individual who is ineligible to enroll, such as a CNA or RN, is generally handled by listing the eligible supervising or ordering physician on the claim. South Dakota Medicaid Referrals manual
An out of state provider that is not enrolled must obtain prior authorization first, and an approval is written as pending enrollment. South Dakota Medicaid Out of State Providers manual After the service, the provider completes a new online enrollment and attaches the claim and the approval notice. South Dakota Medicaid Out of State Providers manual
Where South Dakota enrollments lose money
South Dakota denies claims for services rendered by a provider not enrolled with South Dakota Medicaid. South Dakota Medicaid Provider News, Fall 2025 A claim whose provider information does not match the enrollment record could also be denied. South Dakota Medicaid General Claim Guidance manual Providers must keep their records accurate about business operations and eligibility to render and bill. South Dakota Medicaid provider enrollment
The General Claim Guidance manual says South Dakota Medicaid must receive a claim within 6 months following the month the services were provided. South Dakota Medicaid General Claim Guidance manual The fall 2025 newsletter words the deadline as 6 months of the date of service. South Dakota Medicaid Provider News, Fall 2025 Plan on six months from the date of service.
Timely filing cannot be extended because enrollment records were submitted late. South Dakota Medicaid provider enrollment Where a delay in South Dakota Medicaid's own review pushes a claim past the deadline, an extension may be available, and special claim submission instructions are included in the approval notices. South Dakota Medicaid provider enrollment Since February 6, 2023 that extension is 30 days from the approval notice, down from the six months given earlier, and a copy of the notice goes with each late claim. Updated Provider Enrollment Claim Submission Extension, February 8, 2023
The winter 2026 newsletter says a provider eligible for Original Medicare must be enrolled in it, or Medicaid will not reimburse services for dually eligible recipients. South Dakota Medicaid Provider News, Winter 2026 Medicaid will not accept letters or EOBs about non enrollment as an exception, and a provider must submit a denial letter from Original Medicare or documentation from Medicare that it is not eligible. South Dakota Medicaid Provider News, Winter 2026
Check where you stand before you submit
WeBill Health runs Revenue Velocity Credentialing with 24/7 CAQH and PECOS lifecycle monitoring, so revalidation dates and affiliation gaps are caught before they become suspended claims. Every file gets Human Expert Review from a credentialing specialist before it goes to the South Dakota Department of Social Services.
Sources
- South Dakota Medicaid Provider News, Spring 2026
- South Dakota Medicaid provider enrollment
- South Dakota Medicaid Provider News, Fall 2025
- Updated Provider Enrollment Claim Submission Extension, February 8, 2023
- South Dakota Medicaid Provider News, Winter 2026
- ecfr.gov, title 42.xml
- dss.sd.gov, 05.06.21 Provider Enrollment PE Portal Revalidat
- dss.sd.gov, General Claim Guidance
- dss.sd.gov, Referrals
- dss.sd.gov, Out of State Providers
Revenue Velocity Credentialing
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The Revenue Defense Audit is a free, forensic review of your claims and A/R by the team that would work your account, including providers seeing patients under a payer that cannot pay them yet.
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