ARSD 67:16:35:13. Denied claims

The department may deny a claim for any of the following reasons: (1) The service claimed was not medically necessary; (2) The claim is a duplicate of a prior paid claim; (3) Third-party liability exists; (4) The claim contains data that is logically inconsistent; (5) The time limit for the submission of a claim has expired; (6) The provider or recipient of service was not eligible when the service was provided; (7) The drug is considered less than effective; (8) The service is considered experimental; (9) The claim contains erroneous, incomplete, or missing information; (10) The claim is false or incorrect or violates provisions of this article; or (11) The service is incidental to or an integral part of an allowable service.