# S.D. Codified Laws § 58-17H-30.1: Retroactive denial of paid claim--Restriction--Requirement--Exclusions--Enforcement > South Dakota · Statutes · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-30.1 ## Section - **Citation:** S.D. Codified Laws § 58-17H-30.1 - **Heading:** Retroactive denial of paid claim--Restriction--Requirement--Exclusions--Enforcement - **Jurisdiction:** South Dakota - **Kind:** Statutes - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** SD Code / Title 58 / Chapter 17H / Section 58-17H-30.1 ## Text Except as otherwise provided in this section, a previously paid claim may be recouped, recovered, or retroactively denied by the health carrier only within eighteen months from the date the claim payment was made, if the health carrier has provided written notice of the reason to the provider. This limitation does not apply to a previously paid claim that: (1) Was determined by the health carrier to have been submitted fraudulently or to involve waste or abuse; (2) Is the subject of an adjustment with a different health carrier, administrator, or payor, and the adjustment is not affected by a contractual relationship, association, or affiliation involving claims payment, processing, or pricing; (3) Was for medical services covered by casualty insurance, as defined by §§ 58-9-11 to 58-9-27 , inclusive; (4) Was for medical services covered by a self-insured health plan governed by the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001 to 1461, inclusive (July 6, 2012); (5) Was for medical services covered under medicare, 42 U.S.C. §§ 1395-1395lll, inclusive (March 15, 2025), medicaid, 42 U.S.C. §§ 1396 to 1396w-6, inclusive (July 4, 2025), or any other federal law; (6) Was for medical services covered by workers' compensation, as provided for in title 62; or (7) Was incorrect because the provider or the member was already paid for the medical services identified in the claim. A violation of this section is subject to enforcement by the Division of Insurance under title 58. For purposes of this section, "medical services," do not include dental services, pharmaceutical services, or the provision of prescription drug products or supplies. For purposes of this section, "retroactively deny a previously paid claim" means to retroactively collect claim payments made to a provider by requiring repayment of the payments, reducing other payments currently owed to the provider, withholding or setting off against future payments, or reducing or affecting the future claim payments to the provider in any other manner. Source: SL 2026, ch 200, § 1. ## Nearby sections - [S.D. Codified Laws § 58-17H-1 Definitions](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-1.md) - [S.D. Codified Laws § 58-17H-2 Health benefit plan defined](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-2.md) - [S.D. Codified Laws § 58-17H-3 Urgent care request defined](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-3.md) - [S.D. Codified Laws § 58-17H-4 Applicability of chapter](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-4.md) - [S.D. Codified Laws § 58-17H-5 Health carrier to provide emergency services coverage without requiring prior authorization--Standards for coverage of emergency services](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-5.md) - [S.D. Codified Laws § 58-17H-6 In-network emergency services](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-6.md) - [S.D. Codified Laws § 58-17H-7 Cost-sharing requirements for out-of-network emergency services](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-7.md) - [S.D. Codified Laws § 58-17H-8 Cost-sharing requirements for covered persons--Payments to out-of-network providers](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-8.md) - [S.D. Codified Laws § 58-17H-9 Exceptions for payments by capitated and other plans without negotiated fees](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-9.md) - [S.D. Codified Laws § 58-17H-10 Negotiated amounts for in-network providers for a particular emergency service](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-10.md) - [S.D. Codified Laws § 58-17H-11 General cost-sharing requirements allowed](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-11.md) - [S.D. Codified Laws § 58-17H-12 Access to representative for post-evaluation or post-stabilization services](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-12.md) - [S.D. Codified Laws § 58-17H-13 Health carrier may be deemed to meet emergency medical coverage requirements if met by private accrediting body](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-13.md) - [S.D. Codified Laws § 58-17H-14 Health carrier responsibility for utilization review activities](https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-14.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_SD_T58_C17H_S58-17H-30.1. Check the current official text before relying on it. Not legal advice.