limit the ability of a health carrier to recoup, recover, or retroactively deny previously paid claims.

Limits on insurers reclaiming provider payments

South Dakota's law applies to medical services provided on or after July 1, 2026. Health insurers generally have 18 months after payment to take back or retroactively deny a paid claim. They must give the provider written notice explaining why. This includes collecting payments back or reducing, withholding, or offsetting current or future payments to the provider. Providers returning payments under this rule owe only the original amount, with no added fees, penalties, or interest. The time limit does not apply when the insurer finds fraud, waste, or abuse, or when the provider or member was already paid. Another exception covers adjustments involving a different insurer, administrator, or payer, but only when claims-payment, processing, or pricing contracts, associations, or affiliations do not affect the adjustment. The time limit also excludes services covered by casualty insurance, self-insured health plans governed by federal employee-benefits law (ERISA), Medicare, Medicaid, other federal law, or workers' compensation. Dental services, pharmacy services, and prescription drug products or supplies are outside this medical-services rule. The Division of Insurance enforces violations.