Dakotabilities — Billing Profile & Reimbursement Data

DAKOTABILITIES is effectively a Medicaid-focused provider with no Medicare billing on file and total Medicaid revenue of $77.8M, indicating its operations are concentrated in state-funded waiver and habilitation services rather than traditional Medicare clinical care. The absence of any Medicare claims on file means payer mix is functionally single-payer (Medicaid) for the billing data available.

Revenue is highly concentrated in a narrow set of Medicaid codes: the top three Medicaid codes by revenue together account for 97.5% of the provider’s Medicaid revenue. This concentration shows the organization’s business model is tightly focused on a few service lines rather than a broad portfolio of Medicaid benefits.

T2016 (Habilitation, residential, waiver; per diem) is the single largest revenue driver at $53.6M (69.0% of Medicaid revenue) and represents the core of the provider’s service footprint. The volume (10.3K claims) and ranking — #5 of 21 providers in-state (80th percentile) — indicate DAKOTABILITIES is a significant, though not dominant, residential habilitation provider in South Dakota.

T2020 (Day habilitation, waiver; per diem) is the second major revenue source with $17.8M (22.9% of Medicaid revenue) from 12.9K claims and a #5 of 20 in-state rank (79th percentile). The sizeable per-claim average ($1376) and large claim count suggest a substantial day-program operation complementing the residential habilitation activity.

S0281 (Medical home program, comprehensive care coordination and planning, maintenance of plan) contributes $4.4M (5.7% of Medicaid revenue) from 7.7K claims and ranks #5 of 21 providers (80th percentile), indicating the provider also offers coordinated care/medical home services at scale as part of its waiver package rather than as a minor add-on. This aligns with a service model emphasizing long-term supports and care planning.

Other listed Medicaid codes (T2025, T2028, T2018, T2014, T2035) each account for small shares of revenue individually (each under 1.5% of Medicaid revenue) but reflect a breadth of waiver-related services and supplies (e.g., specialized supplies, unspecified waiver services, supported employment, prevocational supports). These smaller lines suggest integrative ancillary services that support the core residential and day habilitation offerings.

Competitive standing across the major codes is consistent: for the three largest codes DAKOTABILITIES ranks in the 79th–80th percentiles statewide, repeatedly #5 among peers. That pattern describes a stable mid-to-upper-tier competitor in South Dakota’s waiver habilitation market—meaning it is a meaningful regional player without being the single dominant provider.

DAKOTABILITIES has long-tenure in the billing system, with its NPI enumerated on 2007-02-12 (~19 years ago). This longevity supports the interpretation that its concentrated Medicaid revenue streams represent established service lines rather than a recent or transient shift in billing mix.