CARRIER CODE

LAM1R032 RUN: 08/09/24

21:43:08

LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS LOUISIANA DEPARTMENT OF HEALTH - MEDICAL ASSISTANCE PROGRAM

TPL CARRIER FILE LISTING

CARRIER NAME

CARRIER CARRIER ADDRESS-LINE 1

CODE

CARRIER ADDRESS-LINE 2

CITY

AAA LIFE INSURANCE COMPANY AARP AARP HEALTH CARE OPTIONS AAU USA SPORTS ACCREDO ACE AMERICAN INSURANCE ACUITY GROUP

ADMINISTRATIVE CONCEPTS INC

ADMINISTRATIVE SYSTEMS RESEARCH CORP ADVANTAGE HEALTH ADVANTICA BENEFITS ADVANTRA FREEDOM AETNA AETNA DENTAL AETNA HEALTH MANAGEMENT AETNA LIFE AND CASUALTY AETNA PHARMACY MANAGEMENT AFLAC AIG LIFE INSURANCE COMPANY AIG-DENTAL BENEFIT PROVIDERS AITHER HEALTH ALIERA HEALTHCARE ALL SAVERS ALLEGIANCE BENEFIT PLAN MANAGEMENT ALLIANT HEALTH PLANS ALLIED BENEFITS SYSTEMS INC ALLIED NATIONAL ALLSTATE ALLWELL MEDICARE ADVANTAGE ALTA HEALTH STRATEGIES ALTERNATIVE BENEFITS INC ALTERNATIVE INSURANCE RESOURCES INC ALTERNATIVE RISK MANAGEMENT LTD ALTRISK ALWAYSCARE BENEFITS INC AMALGAMATED LIFE INSURANCE COMPANY AMBETTER

AMBETTER ESSENTIAL CARE AMBETTER FROM BUCKEYE COMMUNITY HEA

AMBETTER FROM LOUISIANA HEALTHCARE

AMBETTER FROM MAGNOLIA HEALTH

AMBETTER FROM SUPERIOR HEALTH AMERCO INSURANCE AMERI HEALTH MERCY OF LOUISIANA AMERIBEN

0001-00 17900 N LAUREL PARK DR 3763-00 PO BOX 13999 0522-00 PO BOX 740819 3702-00 PO BOX 189 4182-00 10400 N 25TH AVE 4214-00 436 WALNUT ST 4353-00 1022 HWY COLONY PKWY

SUITE 202 0030-14 994 OLD EAGLE SCHOOL RD

STE 1005 2188-00 PO BOX 6392 2841-00 839 ST CHARLES AVE 3843-00 PO BOX 981607 H084-60 PO BOX 7154 1050-00 PO BOX 14079 3757-00 PO BOX 14094 H573-60 PO BOX 981107 0828-00 151 FORMINGTON AVE 3413-00 PO BOX 398106 0026-00 1932 WYNNTON RD 0002-00 PO BOX 305800 3398-00 PO BOX 1581 4315-00 P O BOX 211440 4230-00 P O BOX 16818 4205-00 P O BOX 31375 3407-00 PO BOX 3018 3289-00 PO BOX 3708 3033-00 PO BOX 909786 4107-00 PO BOX 29186 3594-00 1776 AMERICAN HERITAGE H213-00 8585 ARCHIVES AVE/STE 310 0907-00 PO BOX 671088 4262-00 2601 FLOWERS RD 2976-00 PO BOX 660787 2651-00 814 W NORTHWEST HWY 4304-00 P O BOX 21053 3428-00 PO BOX 98100 1449-00 770 BROADWAY 4367-00 P O BOX 5010

ATTN CLAIMS 4366-00 P O BOX 5010 4216-00 4349 EASTON WAY

STE 300 4368-00 P O BOX 5010

CLAIMS DEPARTMENT 4197-00 111 E CAPITOL ST

#500 4296-00 P O BOX 5010 3167-00 2721 N CENTRAL AVE 4027-00 PO BOX 7322 3662-00 PO BOX 7887

LIVONIA PHILADELPHIA ATLANTA BRIGHTON PHOENIX PHILADEPHIA RIDGELAND

WAYNE

GRAND RAPIDS NEW ORLEANS EL PASO LONDON LEXINGTON LEXINGTON EL PASO HARTFORD MINNEAPOLIS COLUMBUS NASHVILLE NEPTUNE EAGAN LUBBOCK SALT LAKE CITY MISSOULA CORPUS CHRISTI CHICAGO SHAWNEE MISSION JACKSONVILLE BATON ROUGE HOUSTON ATLANTA BIRMINGHAM ARLINGTON HEIGHTS EAGAN BATON ROUGE NEW YORK FARMINGTON

FARMINGTON COLUMBUS

FARMINGTON

JACKSON

FARMINGTON PHOENIX LONDON BOISE

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ST ZIP

PHONE

MI 48152 888-422-7020 PA 19187 800-523-5800 GA 30374 800-523-5800 ME 04009 000-000-0000 AZ 85021 800-803-2523 PA 19106 800-839-1959 MS 39157 855-563-9396

PA 19087 888-293-9229

MI 49516 800-968-3033 LA 70130 866-586-1755 TX 79998 800-507-3800 KY 40742 800-713-5095 KY 40512 800-800-8121 KY 40512 859-264-7354 TX 79998 888-632-3862 CT 06156 888-632-3862 MN 55439 800-238-6279 GA 31999 800-992-3522 TN 37230 212-770-7000 NJ 07754 212-770-7000 MN 55121 833-665-7444 TX 79490 800-252-3684 UT 84131 800-291-2634 MT 59806 800-877-1122 TX 78463 800-811-4793 IL 60690 800-288-2078 KS 66201 800-825-7531 FL 32224 800-521-3535 LA 70809 885-766-1572 TX 77267 800-339-6635 GA 30341 404-451-0376 AL 35266 800-451-4318 IL 60004 847-394-1700 MN 55121 800-392-1770 LA 70898 888-729-5433 NY 10003 212-473-5700 MO 63640 945-241-9999

MO 61640 877-687-1196 OH 43219 877-687-1189

MO 63640 194-524-1629

MS 39201 877-687-1187

MO 63640 877-687-1196 AZ 85004 877-469-3073 KY 40742 866-681-7373 ID 83707 800-786-7930

LAM1R032 RUN: 08/09/24

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LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS LOUISIANA DEPARTMENT OF HEALTH - MEDICAL ASSISTANCE PROGRAM

TPL CARRIER FILE LISTING

CARRIER NAME

CARRIER CARRIER ADDRESS-LINE 1

CODE

CARRIER ADDRESS-LINE 2

CITY

AMERIBEN SOLUTIONS AMERICA FIRST INSURANCE CO AMERICA'S FIRST CHOICE

AMERICAN ADMINISTRATIVE GROUP AMERICAN CONTINENTAL INSURANCE AMERICAN FAMILY INSURANCE AMERICAN FIDELITY ASSURANCE CO. AMERICAN GENERAL GROUP INSURANCE COMPANY AMERICAN HERITAGE LIFE AMERICAN INCOME LIFE INS. CO. AMERICAN LIFE CARE

AMERICAN MARITIME OFFICERS MEDICAL PLAN AMERICAN MEDICAL SECURITY AMERICAN NATIONAL INS. CO. AMERICAN NATIONAL INSURANCE AMERICAN PIONEER AMERICAN PLAN ADMINISTRATORS AMERICAN POSTAL WORKERS UNION AMERICAN PUBLIC LIFE INS. CO. AMERICAN REBUBLIC INS. CO. AMERICAN RETIREMENT LIFE INS CO AMERICAN SENTINEL AMERICAN STERLING INSURANCE CO AMERICORPS BENEFITS AMERIGROUP AMERIHEALTH ADMINISTRATORS AMERITAS LIFE INSURANCE CORP APWU ARCADIAN COMMUNITY CARE

ARCADIAN HEALTH PLAN ARGUS ARKLA GAS CO ASCENSION SMARTHEALTH ASR HEALTH BENEFITS ASRM CORP ASSURANT EMPLOYEE BENEFITS ASSURANT HEALTH ASSURED BENEFITS ADMINISTRATORS

ASSURED LIFE ASSOC (WOODMEN OF THE WORLD) ASSURITY LIFE INSURANCE ATLAS (ZENITH ADMINISTRATORS)

AULTCARE AUXIANT

AV MED AV MED OF LOUISIANA

3083-00 PO BOX 5347 3161-00 PO BOX 16708 4293-00 250 BERRYHILL RD

#311 3495-00 PO BOX 93670 3981-00 PO BOX 1188 1584-00 3099 EAST WASHINGTON AVE 0027-00 PO BOX 25523 0839-00 PO BOX 660238 0033-00 1776 AMERICAN HERITAGE DR 0034-00 PO BOX 2608 2628-00 1100 POYDRAS ST

STE 2600 2796-00 PO BOX 35 1946-00 PO BOX 19032 0041-00 ONE MOODY PLZ 4260-00 P O BOX 1520 3695-00 PO BOX 130 4356-00 18 HEYWARD ST 0706-00 PO BOX 3279 0045-00 PO BOX 925 0046-00 PO BOX 21670 3992-00 PO BOX 300100 3475-00 PO BOX 61140 3325-00 PO BOX 26103 3804-00 PO BOX 23907 H283-00 P O BOX 3193-00 720 BLAIR MIL RD 2110-00 PO BOX 82520 3745-00 PO BOX 1358 3584-00 920 PIERREMONT RD

STE 506 H570-00 PO BOX 4946 3388-00 PO BOX 419090 0930-00 PO BOX 21734 4312-00 P O BOX 37705 4333-00 P O BOX 6392 4188-00 509 S LENOLA RD 3450-00 PO BOX 2940 3317-00 PO BOX 91604 4237-00 8150 N CENTRAL EXPRESSWAY

STE 1700 3908-00 PO BOX 2397 3302-00 PO BOX 82533 4291-00 18861 90TH AVE

STE A 3479-00 PO BOX 6910 3936-00 424 1ST AVE NE

STE 200 3893-00 9400 SOUTH DADELAND BLVD 0988-00 2900 RIDGELAKE DR

BOISE JACKSON COLUMBIA

LUBBOCK BRENTWOOD MADISON OKLAHOMA CITY DALLAS JACKSONVILLE WACO NEW ORLEANS

DANIA GREEN BAY GALVESTON GALVESTON PENSACOLA BROOKLYN SILVER SPRING JACKSON EAGAN AUSTIN HARRISBURG OVERLAND PARK COLUMBIA LOS ANGELES HORSHAM LINCOLN GLEN BURNIE SHREVEPORT

COVINA KANSAS CITY SHREVEPORT OAK PARK GRAND RAPIDS MOORESTOWN CLINTON LUBBOCK DALLAS

OMAHA LINCOLN MOKENA

CANTON CEDAR RAPIDS

MIAMI METAIRIE

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ST ZIP

PHONE

ID 83705 800-786-7930 MS 39236 800-800-1397 SC 29210 888-563-3289

TX 79493 800-323-1726 TN 37027 800-264-4000 WI 53704 800-374-0008 OK 73125 888-454-9783 TX 75266 800-888-2452 FL 32224 800-535-8086 TX 76797 000-000-0000 LA 70163 504-681-3600

FL 33004 800-348-6515 WI 54307 800-232-5432 TX 77550 318-234-5191 TX 77553 800-899-6503 FL 32591 800-999-2224 NY 11249 718-834-1256 MD 20918 800-222-2798 MS 39205 601-981-8681 MN 55121 515-247-2435 TX 78755 800-633-6752 PA 17106 800-692-7338 KS 66225 000-000-0000 SC 29224 803-736-6463 CA 90054 800-600-5552 PA 19044 866-681-7373 NE 68501 800-487-5553 MD 21060 800-222-2798 LA 71106 318-865-1061

CA 91723 800-573-8597 MO 64141 800-792-7487 LA 71151 800-272-7243 MI 48237 800-225-9369 MI 49516 800-968-3033 NJ 08057 800-359-7475 IA 52733 800-328-4316 TX 79490 800-553-7654 TX 75206 800-247-7114

NE 68103 877-492-5870 NE 68501 800-535-6373 IL 60448 312-649-1200

OH 44706 800-505-2858 IA 52401 800-475-2232

FL 33156 305-671-5437 LA 70002 305-671-5437

LAM1R032 RUN: 08/09/24

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LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS LOUISIANA DEPARTMENT OF HEALTH - MEDICAL ASSISTANCE PROGRAM

TPL CARRIER FILE LISTING

CARRIER NAME

CARRIER CARRIER ADDRESS-LINE 1

CODE

CARRIER ADDRESS-LINE 2

CITY

AVERA HEALTH PLAN AVERA HEALTH PLANS AVMA GROUP HEALTH & LIFE AXA EQUITABLE LIFE INSURANCE COMPANY BANKERS FIDELITY BANKERS LIFE AND CASUALTY BANKERS UNITED LIFE ASSURANCE CO. BAY BRIDGE BCS INSURANCE COMPANY

BEACON HEALTH OPTIONS BENEFIT & RISK MANAGENT SERVICES

BENEFIT ADMINISTRATION SERVICES BENEFIT ADMINISTRATION SERVICES,LTD

BENEFIT ADMINISTRATIVE SYSTEMS, LLC BENEFIT ADMINISTRATORS

BENEFIT MANAGEMENT INC BENEFIT MANAGEMENT SERVICES BENEFIT MANAGEMENT SYSTEM BENEFIT PLAN ADMINISTRATORS BENEFIT PLAN SERVICES

BENEFIT SERVICES INC BENEFIT SUPPORT,INC BENESYS INC/BASS ADMINISTRATORS BENICOMP BLUE ADVATAGE ADMINISTRATION OF AR BLUE BELL BENEFITS TRUST BLUE CARE NETWORK BLUE CROSS (REGENCE GROUP ADMIN) BLUE CROSS BLUE SHIELD BLUE CROSS FEB (ANTHEM) BLUE CROSS OF ALABAMA BLUE CROSS OF ALASKA (PREMERA) BLUE CROSS OF ARIZONA BLUE CROSS OF ARKANSAS BLUE CROSS OF ARKANSAS (FEP BLUE CROSS OF ARKANSAS (MED REPL) BLUE CROSS OF CALIFORNIA (ANTHEM) BLUE CROSS OF CALIFORNIA (MED REPL) BLUE CROSS OF COLORADO BLUE CROSS OF CONNECTICUT BLUE CROSS OF DELAWARE BLUE CROSS OF FLORIDA BLUE CROSS OF GEORGIA BLUE CROSS OF GEORGIA (FEP) BLUE CROSS OF HAWAII BLUE CROSS OF IDAHO

4249-00 3816 S ELMWOOD AVE 4383-00 5300 S BROADBAND LN 4228-00 P O BOX 8789 0148-00 PO BOX 1547 4283-00 P O BOX 105652 3812-00 PO BOX 1935 0070-00 PO BOX 1447 4303-00 1101 S CAPITAL OF TEXAS H 4327-00 2 MID AMERICA PLAZA

SUITE 200 3163-00 200 STATE ST 4359-00 80 IRON POINT CIRCLE

STE 200 4232-00 P O BOX 21515 0868-00 613 CRESCENT CIRCLE

STE 201 3512-00 17475 JOVANNA DR 1937-00 9999 BREWSTER LN

STE 100 1869-00 PO BOX 3001 1321-00 PO BOX 98044 3323-00 PO BOX 3859 1489-00 PO BOX 130217 4370-00 1022 HUTTON LN

SUITE 103 3099-00 PO BOX 4138 4233-00 P O BOX 2977 2245-00 PO BOX 81189 4323-00 8310 CLINTON PARK DR 3506-00 PO BOX 1460 4357-00 P O BOX 605 2770-00 25925 TELEGRAPH RD 3797-00 PO BOX 52890 H014-70 PO BOX 98029 3740-00 PO BOX 27401 3463-00 450 RIVER CHASE PKWY E 3756-00 PO BOX 240609 0532-00 PO BOX 13466 0548-00 601 S GAINES ST 3894-00 PO BOX 2181 H584-90 PO BOX 2181 3558-00 PO BOX 60007 H056-40 PO BOX 60007 0835-00 PO BOX 5368 1697-00 PO BOX 533 2888-00 PO BOX 1991 0537-00 PO BOX 1798 0979-00 PO BOX 9907 3926-00 PO BOX 105557 1936-00 PO BOX 860 1234-00 PO BOX 7408

SIOUX FALLS SIOUX FALLS SCOTTSDALE SEACAUCUS ATLANTA CARMEL CEDAR RAPIDS AUSTIN OAKBROOK TERRACE

BOSTON FOLSOM

EAGAN RIDGELAND

HOMEWOOD POWELL

JOPLIN BATON ROUGE PORTLAND TYLER HIGH POINT

AKRON GAINESVILLE LAFAYETTE FORT WAYNE LITTLE ROCK BRENHAM SOUTHFIELD BELLEVUE BATON ROUGE RICHMOND BIRMINGHAM ANCHORAGE PHOENIX LITTLE ROCK LITTLE ROCK LITTLE ROCK LOS ANGELES LOS ANGELES DENVER NORTH HAVEN WILMINGTON JACKSONVILLE COLUMBUS ATLANTA HONOLULU BOISE

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ST ZIP

PHONE

SD 57105 888-322-2115 SD 57108 605-322-4545 AZ 85252 800-621-6360 NJ 07096 800-782-9355 GA 30348 866-458-7499 IN 46082 317-817-6300 IA 52406 800-637-6318 TX 78746 512-329-5069 IL 60181 630-472-7700

MA 02109 617-747-1100 CA 95630 916-467-1401

MN 41205 800-788-8771 MS 39157 601-605-0072

IL 60430 708-799-7400 OH 43065 614-336-2700

MO 64803 417-782-1515 LA 70898 704-845-5608 ME 04104 800-242-6226 TX 75713 701-237-4787 NC 27262 225-987-4561

OH 44321 330-666-0337 GA 30503 770-532-2690 LA 70598 248-813-9800 IN 46825 260-482-7400 AR 72203 800-370-5790 TX 77834 979-830-7388 MI 48034 800-810-2583 WA 98015 000-000-0000 LA 70898 800-599-2583 VA 23279 800-599-2583 AL 35298 855-525-7283 AK 99524 800-722-1471 AZ 85002 800-528-0716 AR 72203 800-827-4814 AR 72203 800-827-4814 AR 72203 800-827-4814 CA 90060 800-777-6000 CA 90060 800-777-6000 CO 80217 800-533-5643 CT 06473 800-922-6621 DE 19899 800-633-2563 FL 32231 877-352-2583 GA 31908 800-718-8831 GA 30348 800-282-2473 HI 96808 800-776-4672 ID 83707 800-274-4018

LAM1R032 RUN: 08/09/24

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LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS LOUISIANA DEPARTMENT OF HEALTH - MEDICAL ASSISTANCE PROGRAM

TPL CARRIER FILE LISTING

CARRIER NAME

CARRIER CARRIER ADDRESS-LINE 1

CODE

CARRIER ADDRESS-LINE 2

CITY

BLUE CROSS OF IDAHO (FEP) BLUE CROSS OF ILLINOIS BLUE CROSS OF ILLINOIS (CHICAGO) BLUE CROSS OF ILLINOIS (DENTAL) BLUE CROSS OF INDIANA BLUE CROSS OF IOWA BLUE CROSS OF KANSAS BLUE CROSS OF KENTUCKY (ANTHEM) BLUE CROSS OF LOUISIANA BLUE CROSS OF LOUISIANA (FEP) BLUE CROSS OF MAINE BLUE CROSS OF MARYLAND BLUE CROSS OF MASSACHUSETTS BLUE CROSS OF MICHIGAN BLUE CROSS OF MICHIGAN (MED REPL) BLUE CROSS OF MINNESOTA BLUE CROSS OF MISSISSIPPI BLUE CROSS OF MISSOURI (ANTHEM) BLUE CROSS OF MISSOURI (KC) BLUE CROSS OF MISSOURI (ST LOUIS) BLUE CROSS OF MONTANA BLUE CROSS OF NEBRASKA BLUE CROSS OF NEVADA BLUE CROSS OF NEW JERSEY BLUE CROSS OF NEW JERSEY (EXCELLUS) BLUE CROSS OF NEW MEXICO BLUE CROSS OF NEW YORK (EMPIRE) BLUE CROSS OF NEW YORK (EXCELLUS) BLUE CROSS OF NEW YORK (NORTHEASTERN) BLUE CROSS OF NEW YORK (ROCHESTER) BLUE CROSS OF NEW YORK (WESTERN) BLUE CROSS OF NORTH CAROLINA BLUE CROSS OF NORTH DAKOTA BLUE CROSS OF OHIO BLUE CROSS OF OHIO (ANTHEM) BLUE CROSS OF OKLAHOMA BLUE CROSS OF OREGON BLUE CROSS OF PENNSYLVANIA BLUE CROSS OF PENNSYLVANIA (HGHMRK) BLUE CROSS OF PENNSYLVANIA (IND) BLUE CROSS OF RHODE ISLAND BLUE CROSS OF SOUTH CAROLINA BLUE CROSS OF SOUTH DAKOTA BLUE CROSS OF TENNESSEE BLUE CROSS OF TEXAS BLUE CROSS OF UTAH BLUE CROSS OF VERMONT BLUE CROSS OF VIRGINIA-ANTHEM BLUE CROSS OF WASHINGTON (KING COUNTY MEDICAL) BLUE CROSS OF WASHINGTON (PREMERA) BLUE CROSS OF WASHINGTON & ALASKA

4211-00 3000 E PINE AVE 0543-00 233 N MICHIGAN AVE 0535-00 PO BOX 805107 3840-00 PO BOX 23059 0964-00 PO BOX 62509 0539-00 636 GRAND AVE 0837-00 PO BOX 239 3551-00 PO BOX 37180 0546-00 PO BOX 98029 2601-00 PO BOX 98029 1405-00 PO BOX 8884 0542-00 PO BOX 14115 0545-00 PO BOX 986030 0544-00 600 LAFAYETTE EAST H231-90 PO BOX 440 1708-00 PO BOX 64061 0515-00 PO BOX 1043 1366-00 PO BOX 14882 1251-00 PO BOX 419169 0533-00 444 FOREST PARK 2441-00 PO BOX 50004 1402-00 PO BOX 3248 2051-00 PO BOX 10330 0947-00 PO BOX 420 3451-00 165 COURT ST 2916-00 PO BOX 27630 0928-00 PO BOX 3877 3809-00 PO BOX 22999 0536-00 PO BOX 15013 1023-00 343 STATE ST 0746-00 PO BOX 80 1058-00 PO BOX 35 3181-00 4510 13TH AVE SW 2693-00 PO BOX 94754 3448-00 9075 CENTRE POINT DR 0521-00 PO BOX 3283 1270-00 PO BOX 1271 1657-00 PO BOX 62 3498-00 PO BOX 3355 3481-00 1901 MARKET ST 1158-00 444 WESTMINSTER MALL 3492-00 PO BOX 100605 3145-00 1601 WEST MADISON 0880-00 801 PINE ST 3537-00 PO BOX 660044 1818-00 PO BOX 30272 2856-00 PO BOX 186 4229-00 P O BOX 27401 1276-00 PO BOX 91015 3672-00 PO BOX 91059 1196-00 PO BOX 327

MERIDIAN CHICAGO CHICAGO BELLEVILLE VIRGINIA BEACH DES MOINES TOPEKA LOUISVILLE BATON ROUGE BATON ROUGE PORTLAND LEXINGTON BOSTON DETROIT SOUTHFIELD ST PAUL JACKSON SAINT LOUIS KANSAS CITY ST LOUIS BUTTE OMAHA RENO NEWARK ROCHESTER ALBUQUERQUE NEW YORK ROCHESTER ALBANY ROCHESTER BUFFALO DURHAM FARGO CLEVELAND WESTCHESTER TULSA PORTLAND CAMPHILL PITTSBURGH PHILADELPHIA PROVIDENCE COLUMBIA SIOUX FALLS CHATTANOOGA DALLAS SALT LAKE CITY MONTPELIER RICHMOND SEATTLE SEATTLE SEATTLE

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ST ZIP

PHONE

ID 83642 800-627-6656 IL 60601 800-538-8833 IL 60680 312-653-6000 IL 62223 877-860-2837 VA 23466 800-382-5520 IA 50307 800-362-2218 KS 66601 888-989-8842 KY 40233 800-880-2583 LA 70898 800-599-2583 LA 70898 800-599-2583 ME 04104 800-422-4304 KY 40512 410-581-3000 MA 02298 800-262-2583 MI 48226 313-225-9000 MI 48037 313-225-9000 MN 55164 800-382-2000 MS 39205 800-222-8046 MO 63178 800-932-4480 MO 64141 800-451-2348 MO 63108 800-932-4480 MT 59701 406-447-8600 NE 68180 800-821-4787 NV 89520 800-727-4060 NJ 07101 800-624-5078 NY 14647 800-201-8868 NM 87125 800-835-8699 NY 10008 212-476-1000 NY 14692 800-524-2461 NY 12212 800-888-1238 NY 14650 800-676-2583 NY 14240 800-856-0480 NC 27702 800-922-6621 ND 58121 800-874-2656 OH 44101 800-282-1016 OH 45069 800-282-1016 OK 74102 800-722-3130 OR 97207 866-227-0913 PA 17001 800-235-4999 PA 15230 800-544-6679 PA 19101 800-555-1514 RI 02901 800-327-6712 SC 29260 800-222-7156 SD 57104 800-831-4818 TN 37402 800-565-9140 TX 75266 800-521-2227 UT 23279 800-624-6519 VT 05601 800-344-6690 VA 23279 804-358-1551 WA 98111 800-875-4422 WA 98111 800-875-4422 WA 98111 206-670-4000

LAM1R032 RUN: 08/09/24

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LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS LOUISIANA DEPARTMENT OF HEALTH - MEDICAL ASSISTANCE PROGRAM

TPL CARRIER FILE LISTING

CARRIER NAME

CARRIER CARRIER ADDRESS-LINE 1

CODE

CARRIER ADDRESS-LINE 2

CITY

BLUE CROSS OF WEST VIRGINIA BLUE CROSS OF WISCONSIN (ANTHEM) BLUE CROSS OF WYOMING BLUE CROSS PENNSYLVANIA (WESTERN) BLUE SHIELD OF CALIFORNIA BLUE SHIELD OF PUERTO RICO BMI BENEFIT BOLLINGER EMPLOYEES HEALTHCARE PLAN BOON CHAPMAN BOON GROUP BRECKPOINT INSURANCE

BRIGHT HEALTHCARE BROKERAGE CONCEPTS BUSINESS ADMINISTRATORS AND CONSULTANTS INC CALIFORNIA IRONWORKERS FIELD WELFARE PLAN CAPITAL BLUECROSS CAPITAL RX

CAPITOL ADMINISTRATORS

CAPITOL DISTRICT PHYSICIANS HEALTH CAPROCK HEALTH GROUP CAREFIRST CAREINGTON INTERNATIONAL CAREMARK CAREMORE CAREPLUS HEALTH PLANS INC CARESOURCE CARPENTERS HEALTH & SECURITY TRUST CATALYST RX CBA BLUE CBCA ADMINISTRATORS CCMSI

CELTIC INSURANCE COMPANY CELTIC LIFE INS. CO.

CENTRAL STATES HEALTH & LIFE CO. OF OMAHA CENTRAL STATES INDEMNITY CENTRAL STATES INS CO CENTURY HEALTHCARE CERNER HEALTH PLANS CERPASS RX CHEROKEE INSURANCE COMPANY CHEROKEE NATIONAL LIFE INS. CO. CHESTERFIELD RESOURCES INC CHITIMACHA EMPLOYEES HEALTH PLAN CHRISTIAN BROTHERS CHRISTIAN CARE MEDI-SHARE CHRISTIAN FIDELITY LIFE INS COMPANY

1432-00 PO BOX 7026 3998-00 PO BOX 105187 1190-00 PO BOX 2266 0538-00 PO BOX 358 4270-00 4203 TOWN CENTER BLVD 2822-00 PO BOX 363628 4288-00 P O BOX 511 3729-00 PO BOX 706 0971-00 PO BOX 9201 4175-00 P O BOX 559017 4246-00 5130 S FORT APACHE

#215-365 4334-00 P O BOX 16275 3931-00 801 LAKEVIEW DR 2952-00 PO BOX 107 0855-00 475 HUNTINGTON DR 4199-00 P O BOX 211457 4342-00 228 PARK AVE

STE 87234 4236-00 10951 WHITE ROCK RD

STE 100 4274-00 17 COLUMBIA CIRCLE 4243-00 11467 HUEBNER RD/STE 3 3340-00 10455 MILL RUN CIRCLE 3009-00 13155 NOEL RD 3744-00 PO BOX 52196 H054-40 PO BOX 366 H101-00 PO BOX 14697 4360-00 P O BOX 8738 3723-00 PO BOX 1929 3220-00 PO BOX 44036 3850-00 PO BOX 2365 3305-00 PO BOX 16579 3210-00 2 EAST MAIN ST

TOWN CENTRE BUILDING 3914-00 PO BOX 26440 0086-00 208 S LASALLE ST

STE 1644 0091-00 PO BOX 34350 4013-00 1212 N 96TH ST 0090-01 10425 W NORTH AVE 3489-00 PO BOX 2256 3980-00 PO BOX 188061 4213-00 ONE COWBOYS WAY/STE 290 4110-00 34200 MOUND RD 0095-00 1122 GRAY HWY 1350-00 PO BOX 1884 2774-00 PO BOX 39 0885-00 1205 WINDHAM PKWY 3482-00 P O BOX 981652 0949-00 2001 BATES DR

WHEELING ATLANTA CHEYENNE PITTSBURGH EL DORADO HILLS SAN JUAN MATAWAN SHORT HILLS AUSTIN AUSTIN LAS VEGAS

READING BLUE BELL REYNOLDSBURG SAN MARINO EAGAN NEW YORK

RANCHO CORDOVA

ALBANY SAN ANTONIO OWINGS MILL DALLAS PHOENIX ARTESIA LEXINGTON DAYTON SEATTLE BATON ROUGE SOUTH BURLINGTON SAVANNAH DANVILLE

LITTLE ROCK CHICAGO

OMAHA OMAHA WAUWATOSA GRAPEVINE CHATTANOOGA FRISCO STERLING HEIGHTS MACON AKRON CHARENTON ROMEOVILLE EL PASO WAXAHACHIE

TP-0-32-2

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ST ZIP

PHONE

WV 26105 800-535-5266 GA 30348 800-242-7164 WY 72211 307-634-1393 PA 15230 215-241-2400 CA 95762 800-393-6130 PR 00936 877-357-9777 NJ 07747 800-445-3126 NJ 07078 800-526-1379 TX 87866 800-252-9653 TX 78755 800-368-2666 NV 89148 800-638-5216

PA 19612 877-714-3222 PA 19422 877-224-3486 OH 21060 614-863-8780 CA 91108 213-385-0551 MN 55121 800-962-2242 NY 10003 888-832-2779

CA 95670 800-654-6701

NY 12203 800-926-7526 TX 78230 800-747-9446 MD 21117 410-581-3000 TX 75240 800-290-0523 AZ 85072 800-929-2524 CA 90702 800-499-2793 KY 40512 800-794-5907 OH 45401 800-488-0134 WA 98111 877-738-6655 LA 70804 888-869-4600 VT 05407 888-222-9206 GA 31416 800-824-3882 IL 61832 800-252-5059

AR 72221 800-477-7870 IL 60604 800-477-7870

NE 68134 800-323-2190 NE 68114 800-323-2190 WI 53226 800-323-2190 TX 76099 888-444-1995 TN 37422 877-765-1033 TX 75034 844-636-7506 MI 48310 800-201-0450 GA 31201 800-201-0450 OH 44309 330-896-2232 LA 70523 337-923-4343 IL 60446 800-807-0400 TX 79998 800-772-5623 TX 75167 866-641-9999

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