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LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 1 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP "THE COMPANY" A T AND T PLAN A. COPELAND ENTERPRISES INC A-G ADMINISTRATORS A-1 SERVICE COMPREHENSIVE HEALTH INSURANCE AAA COOPER (SELF INSURED) AAA LIFE INSURANCE COMPANY AAG BENEFITS AARP AARP HEALTH CARE OPTIONS AARP-UNITED HEALTHCARE AAU USA SPORTS ABB VETCO GRAY (SELF FUNDED) INC ABBOTT LABORATORIES HEALTH PLAN ABI ADMINISTRATIVE SER. ABRAZO ADVANTAGE HEALTH PLAN 2282-00 1566-00 1511-00 2535-00 1271-00 1312-00 0001-00 3237-00 3763-00 0522-00 3612-00 3702-00 2928-00 1186-00 1299-00 H598-50 LAGUNA HILLS SHREVEPORT JEFFERSON VALLEY FORGE JEFFERSON DOTHAN FAIRFAX DALLAS PHILADELPHIA ATLANTA ATLANTA BRIGHTON LAFAYETTE CHICAGO MINNETONKA PHOENIX CA LA LA PA LA AL VA TX PA GA GA ME LA IL MN AR 92654 71118 70121 19482 70121 36302 22033 75261 19187 30374 30374 04009 70562 60690 55343 85020 ACACIA MUTUAL LIFE INSURANCE COMPANY ACADEMY LIFE INSURANCE COMPANY ACADIA BENEFIT OF THE SOUTH INC ACADIAN HEALTH CARE ALLIANCE ACBL MEDICARE SUPPLEMENT ACCELERATION LIFE INSURANCE COMPANY 0003-00 0004-00 2232-00 2859-00 0788-00 1514-00 WASHINGTON VALLEY FORGE DELUTH LAFAYETTE DES MOINES MONROE DC PA GA LA IA LA 20001 19487 30136 70505 50398 71201 ACCESS INSURANCE COMPANY ACCREDITED TRUST LIFE INSURANCE COMPANY ACMG ACOG GROUP INSURANCE PLANS ACORDIA BENEFITS OF FLORIDA ACORDIA LOCAL GOVERNMENT BENEFITS IINC ACORDIA NATIONAL ACORDIA OF LEXINGTON INC ACORDIA OF MISSISSIPPI ACORDIA SMALL BUSINESS BENEFITS OF THE SOUTHWEST INC 3213-00 0005-00 2041-00 1129-00 2337-00 2097-00 2506-00 2733-00 2701-00 2165-00 LAFAYETTE PHOENIX MIAMISBURG CHICAGO W PALM BEACH INDIANAPOLIS CHARLESTON LEXINGTON RIDGELAND CORPUS CHRISTI LA AZ OH IL FL IN WV KY MS TX 70508 85016 45342 60601 23401 46268 25332 40583 39158 78411 ACS BENEFITS SERVICES 3101-00 DALLAS TX 75354 ACTION INDUSTRIES HEALTH CARE PLAN ADJUSTCO, INC. ADMAR CORPORATION ADMIN ONE ADMINISTRATIVE BENEFITS CONSULTANTS INC 3074-00 2455-00 2847-00 3126-00 1727-00 PONTOTOC MILWAUKEE SANTA ANA ROGERS ATLANTA MS WI CA AR GA 38863 53202 92702 72757 30341 ADMINISTRATIVE ADMINISTRATIVE ADMINISTRATIVE ADMINISTRATIVE ADMINISTRATIVE 1843-00 0030-14 3014-00 2309-00 2395-00 P O BOX 31000 MANSFIELD RD 1333 S CLEARVIEW PKWY P O BOX 979 555 COOLIDGE ST P O BOX 6827 12600 FAIRLAKES CIRCLE P O BOX 619070 P O BOX 13999 P O BOX 740819 P O BOX 740819 P O BOX 189 1249 EVANGELINE THRUWAY P O BOX 463 10159 WAYZETOR BLVD 7878 NORTH 16TH ST SUITE 105 51 LOUISIANA AVENUE, N.W. ONE VALLEY FORGE PLAZA 3577 KOGER BLVD/STE 400 P O BOX 51102 400 LOCUST ST 1400 ROYAL AVE P O BOX 4705 1720 KALISTE SALOOM 4808 NORTH 22ND STREET 2570 TECHNICAL DR #1 E WACKER DRIVE 501 S SLAGLER OR STE 600 5451 W LAKEVIEW PKWY S. P O BOX 3262 P O BOX 13307 P O BOX 6012 5656 S STAPLES SUITE 330 MEDICAL CONTROL P O BOX 549005 P O BOX A 330 EAST KILBOURN/STE 380 P O BOX 478 P O BOX 2619 P O BOX 80809 12 PERIMETER PK SUITE 115 6099 MOUNT MORIAH RD #19 P O BOX 1749 P O BOX 1749 7122 N 27TH AVE #200 3800 N WILKE RD SUITE 250 3371 E ROYALTON RD P O BOX 839000 MEMPHIS ROCKWALL ROCKWALL PHOENIX ARLINGTON HTS TN TX TX AZ IL 38115 75087 75087 85051 60004 BROADVIEW HEIGHTS MIAMI OH FL 44147 33283 BENEFITS SERVICES CONCEPTS INC CONCEPTS,INC ENTERPRISES INC MANAGEMENT GROUP ADMINISTRATIVE SERVICE CONSULTANTS ADMINISTRATIVE SERVICES INC 2448-00 2881-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 2 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP ADMINISTRATIVE SOLUTIONS INC ADMINISTRATIVE SYSTEMS RESEARCH CORP ADMINISTRATORS & CONSULTANTS LTD ADMINITRON INC ADMIRAL LIFE INSURANCE CO. OF AMERICA ADRIEN'S SUPERMARKET INC (SELF-INSURED) ADVANCE PARADIGM ADVANCED BENEFITS SOLUTIONS ADVANCED INSURANCE SERVICES INC ADVANCED PRESCRIPTION MANAGEMENT ADVANTAGE DENTAL 2894-00 2188-00 2640-00 3120-00 0006-00 1972-00 2716-00 3077-00 1323-00 2330-00 1837-00 NORCROSS GRAND RAPIDS LANCASTER BRENTWOOD MINNEAPOLIS LAFAYETTE RICHARDSON PHOENIX MEMPHIS DALLAS DALLAS GA MI PA TN MN LA TX AZ TN TX TX 30091 49516 17604 37024 55402 70508 75035 85066 38101 75381 75367 ADVANTAGE HEALTH 2841-00 NEW ORLEANS LA 70130 ADVANTICA BENEFITS ADVANTICAL EYECARE 3843-00 3625-00 EL PASO ELLICOTT CITY TX MD 79998 21042 ADVANTRA ADVANTRA FREEDOM AEGON INSURANCE GROUP AEORDIA BENEFITS OF THE SOUTH INC H714-90 H084-60 2084-00 2382-00 LONDON LONDON LITTLE ROCK DELLUTH KY KY AR GA 40742 40742 72203 30136 AEROPRES CORPORATION AETNA AETNA AETNA AETNA AETNA AETNA AETNA AETNA AETNA AETNA AETNA AETNA AETNA AETNA BETTER HEALTH OF LOUISIANA 2484-00 2473-00 2649-00 3491-00 3399-00 2294-00 1170-00 1050-00 3875-00 3852-00 3641-00 3571-00 0726-00 0528-00 9999-95 SHREVEPORT ARLINGTON METAIRIE EL PASO LEXINGTON SAN ANTONIO ARLINGTON LEXINGTON LEXINGTON PENSACOLA BISMARK COLUMBIA MIDDLETOWN TYLER METAIRIE LA TX LA TX KY TX TX KY KY FL ND SC CT TX LA 71137 76015 70002 79998 40512 78279 76015 40512 40512 32591 58502 29224 06457 75710 70002 AETNA AETNA AETNA AETNA AETNA AETNA AETNA AETNA AETNA AETNA AETNA AETNA AETNA 3757-00 3493-00 0714-00 H573-60 INT9-95 1338-00 0759-00 0828-00 1045-00 0007-00 0828-01 1199-00 3386-00 P O BOX 2547 P O BOX 6392 P O BOX 4925 P O BOX 5095 910 PLYMOUTH BUILDING 107 D KALISTE SALOOM RD P O BOX 853901 P O BOX 30570 P O BOX 1842 P O BOX 819056 PAT HANEYSSON AGENCY P O BOX 67062 839 ST CHARLES AVE STE 100 P O BOX 981607 3290 PINE ORCHARD LANE STE D P O BOX 7705 P O BOX 7154 P O BOX 8063 3575 KROGER BLVD SUITE 450 P O BOX 70100 P O BOX 91555 3900 N CAUSEWAY BLVD P O BOX 981106 P O BOX 14100 P O BOX 795080 P O BOX 91511 P O BOX 14079 P O BOX 14588 P O BOX 13441 P O BOX 916 P O BOX 23759 1000 MIDDLE STREET P O BOX 2520 3838 N CAUSEWAY BLVD 33RD FLR P O BOX 14094 P O BOX 981543 P O BOX 30167 P O BOX 981107 3838 N CAUSEWAY/33RD FLR 1000 MIDDLE STREET 1000 MIDDLE STREET 151 FORMINGTON AVE P O BOX 14586 1000 MIDDLE STREET P O BOX 937 P O BOX 12340 P O BOX 398106 LEXINGTON EL PASO TAMPA EL PASO METAIRIE MIDDLETOWN MIDDLETOWN HARTFORD LEXINGTON MIDDLETOWN TOLEDO FRESNO MINNEAPOLIS KY TX FL TX LA CT CT CT KY CT OH CA MN 40512 79998 33630 79998 70002 06457 06457 06156 40512 06457 43695 93765 55439 DENTAL GLOBAL BENEFITS GOVERNMENT WIDE INDEMNITY BENEFIT PLAN HEALTH MANAGEMENT INTEREST PAYMENTS LIFE & CAS LIFE AND A LIFE AND CASUALTY LIFE INS CO LIFE INSUR LIFE INSURANCE CO LIFE INSURANCE CO PHARM MANAGMNT LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 3 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP AETNA AETNA AETNA AETNA 3413-00 3020-00 0725-00 3772-00 P O BOX 398106 P O BOX 1125 P O BOX 981109 2425 W LOOP SOUTH SUITE 1000 P O BOX 51005 P O BOX 4661 P O BOX 10787 P O BOX 342677 1325 MASSACHUSETTS AVE 17775 AIRLINE HWY 4150 S. 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P O BOX 3018 P O BOX 1239 P O BOX 5147 4020 MCEWGN SUITE 285 P O BOX 89454 SRC P O BOX 23759 911 BROADWAY P O BOX 419233 POST OFFICE BOX 1527 P O BOX 909786 P O BOX 29200 440 LINCOLN ST 1776 AMERICAN HERITAGE CLAIMS FILING P O BOX 9016 MINNEAPOLIS BLUE BELL EL PASO HOUSTON MN PA TX TX 55439 19422 79998 77027 SHREVEPORT HOUSTON BURBANK AUSTIN WASHINGTON BATON ROUGE BATON ROUGE SOLON MEMPHIS APPLETON WILMINGTON NEPTUNE SUGARLAND LA TX CA TX DC LA LA OH TN WI DE NJ TX 71135 77210 91510 78734 20005 70769 70816 44139 38187 54919 19899 07754 77479 MEMPHIS AKRON BIRMINGHAM BIRMINGHAM ANCHORAGE TN OH AL AL AK 38101 44309 35283 35236 99503 SEATTLE BOISE FARMINGTON HILLS ALEXANDRIA ALEXANDRIA NORTHVILLE NEW YORK ENGLEWOOD CHICAGO WA ID MI LA LA MI NY CO IL 98124 83707 48018 71306 71309 48167 10116 80111 60631 LONGWOOD MISSOULA FORT VALLEY SPRINGFIELD DALLAS CLEVELAND COLUMBIA KANSAS CITY KANSAS CITY DALLAS CHICAGO ST LOUIS WORCHESTER JACKSONVILLE N SUBURBAN FL MT GA IL TX OH SC MO MO TX IL MO MA FL IL 32750 59806 31030 62705 75244 44101 29224 64105 64141 75221 60690 63126 01605 32224 60199 PHARMACY MANAGEMENT U. S. HEALTHCARE US HEALTHCARE US HEALTHCARE AFCO INDUSTRIES INC AFFILIATED HEALTHCARE INC AFFORDABLE BENEFITS ADMINISTRATORS AFFORDABLE HEALTH CARE AFGE HEALTH BENEFIT PLAN AFU INSURANCE FUND AGENCY MANAGEMENT CORPORATION AGENCY RENT A CAR HOSPITALIZATION AGENCY SERVICES INC AID ASSOCIATION FOR LUTHERANS AIG LIFE INSURANCE COMPANY AIG-DENTAL BENEFIT PROVIDERS AIM ADMINISTRATORS 1987-00 2561-00 3377-00 3274-00 0838-00 2469-00 1667-00 2471-00 3142-00 1495-00 0002-00 3398-00 3174-00 AIS AKRON CITY HOSPITAL (SELF-INSURED) ALA HEALTH NETWORK ALABAMA DENTAL ASSOC.HEALTH TRUST INS ALASKA ELECTRICAL TR FUND 2436-00 1451-00 2200-00 0976-00 3847-00 ALASKA PIPE TRADES WELFARE & PENSION SERVICE ALBERTSON'S EMPLOYEE HEALTH AND WELFARE ALEXANDER HAMILTON LIFE INS. CO. OF AMERICA ALEXANDRIA NEWSPAPER INCORPORATED ALEXANDRIA SEED CO (SELF-INSURED) ALEXSIS ALICARE INC ALL AMERICAN ASSURANCE COMPANY ALL AMERICAN LIFE INS. CO. 3136-00 1293-00 0008-00 1466-00 2374-00 1881-00 3139-00 0009-00 0010-00 ALL RISK CORPORATION OF LOUISIANA ALLEGIANCE BENEFIT PLAN MANAGEMENT ALLEN MEDICAL CLAIMS ADMINISTRATOR INC ALLIANCE LIFE INSURANCE COMPANY ALLIANCE PRESCRIPTION CHOICE ALLIANT HEALTH PLANS ALLIANZ ALLIED ADMINISTRATORS ALLIED ASSOCIATION ALLIED BANKERS LIFE INSURANCE COMPANY ALLIED BENEFITS SYSTEMS INC ALLIED EMPLOYER'S ASSOCIATION ALLMERICA INSURANCE ALLSTATE ALLSTATE LIFE INSURANCE CO 0523-00 3407-00 2642-00 0011-00 1602-00 3289-00 2863-00 1272-00 2404-00 0012-00 3033-00 1226-00 2635-00 3594-00 0013-01 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 4 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP ALLSTATE LIFE INSURANCE COMPANY ALLSTATE WORKPLACE DIVISION ALPHA CORPORATION 0013-00 3457-00 1303-00 NORTHBROOK RICHARDSON BATON ROUGE IL TX LA 60062 75085 70898 ALTA HEALTH ALTA RX ALTERNATIVE ALTERNATIVE ALTERNATIVE 0907-00 2150-00 1705-00 2976-00 2651-00 ALLSTATE PLAZA P O BOX 853916 8322 ONE CALAIS AVE P O BOX 14786 P O BOX 671088 P O BOX 54190 P O BOX 26841 P O BOX 660787 3275 N ARLINGTON HTS RD SUITE 401 P O BOX 80139 7380 NORTH LINCOLN AVENUE 770 BROADWAY 120 N MADISON ST 5353 ESSEN LANE SUITE 450 P O BOX 35750 #1 HESS PLAZA 2721 N CENTRAL AVE 14180 DALLAS PARKWAY SUITE 504 P O BOX 7186 P O BOX 5347 P O BOX 16708 P O BOX 398220 P O BOX 93670 4334 NW EXPRESSWAY STE 207 P O BOX 53070 1903 W CHURCH ST POST OFFICE BOX 7430 P O BOX 6456 12600 NORTHBOROUGH DR SUITE 300 3200 EAST CARSON STREET P O BOX 1579 POST OFFICE BOX 1700 11222 QUAIL ROOST DRIVE P O BOX 469 POST OFFICE BOX 2228 2626 S SHERIDAN STE 200 POST OFFICE BOX 42814 1707 ORLANDO CENT.PARKWAY 406 E WILSON BRIDGE RD STE.C P O BOX 1009 P O BOX 610 PHA INC 18 POIMER STREET 39201 SEVEN MILE ROAD HOUSTON LOS ANGELES OKLAHOMA CITY BIRMINGHAM ARLINGTON HEIGHTS TX CA OK AL IL 77267 90054 73126 35266 60004 BATON ROUGE LINCOLNWOOD NEW YORK THOMASVILLE BATON ROUGE LA IL NY GA LA 70898 60646 10003 31792 70809 TULSA WOODBRIDGE PHOENIX DALLAS OK NJ AZ TX 74153 07095 85004 75240 BOISE BOISE JACKSON MINNEAPOLIS LUBBOCK OKLAHOMA CITY ID ID MS MN TX OK 83707 83705 39236 55439 79493 73116 LUBBOCK HAMMOND ATLANTA METAIRIE HOUSTON TX LA GA LA TX 79453 70401 30357 74009 77067 LAKEWOOD OPELOUSAS WACO MIAMI BILOXI DECATUR TULSA CA LA TX FL MS AL OK 90712 70571 76703 33157 39533 35602 74129 HOUSTON ORLANDO WORTHINGTON TX FL OH 77242 32809 43085 LANGHORNE JEFFERSONVILLE LOWELL PA IN MA 19047 47130 01852 LIVONIA MI 48152 STRATEGIES BENEFIT CONSULTANTS INSURANCE RESOURCES INC RISK MANAGEMENT LTD ALWAYSCARE BENEFITS INC AMALGAMATED LABOR LIFE INS. CO AMALGAMATED LIFE INSURANCE COMPANY AMBASSDOR AMCARE HEALTH PLAN OF LOUISIANA 3428-00 0014-00 1449-00 3661-00 3023-00 AMCARE HEALTH PLAN OF OKLAHOMA AMERADA HESS CORPORATION AMERCO INSURANCE AMERI PLAN USA 2990-00 2276-00 3167-00 2791-00 AMERIBEN AMERIBEN SOLUTIONS AMERICA FIRST INSURANCE CO AMERICA TPA AMERICAN ADMINISTRATIVE GROUP AMERICAN ADMINISTRATIVE INC 3662-00 3083-00 3161-00 3958-00 3495-00 2992-00 AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN ADMINISTRATORS GROUP ADVANTAGE INSURANCE AGENCY LIFE INS. CO. AMBULANCE AND MEDICAL RESCUE SERVICE ASSOCIATION OF PETROLEUM LANDMEN 3316-00 1157-00 0015-00 0809-00 1069-00 AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN ASSOCIATION OF RETIRED PERSONS BANK & TRUST CO. (SELF-INSURED) BANKERS INSURANCE COMPANY BANKERS LIFE ASSUR. CO. OF FL BENEFIT ADMINISTRATORS INC BENEFIT LIFE INS. CO. BENEFITS CO INC 1373-00 2419-00 0017-00 0018-00 1890-00 0019-00 3211-00 AMERICAN CAPITOL INS. CO. AMERICAN CASUALTY CO AMERICAN CHAMBERS LIFE INS. CO. 0020-00 0986-00 0021-00 AMERICAN COMBINED LIFE INSURANCE COMPANY AMERICAN COMMERCIAL BARGE-LINE AMERICAN COMMERCIAL TRUST AND HEALTH 2490-00 1353-00 0923-00 AMERICAN COMMUNITY MUTUAL INS. CO. 0022-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 5 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN CONSULTING ENGINEERS COUNC CONSUMERS LIFE INS. CO. CONTINENTAL INSURANCE COTTON GROWERS, PCCA TEXTILE DIVISION CYANAMID CO. DEFENDER LIFE INS. CO. DENTAL PLAN INC EDUCATORS LIFE INSURANCE EMPLOYERS BENEFIT TRUST MEDICAL PLAN EQUITABLE LIFE INS. CO. EXCESS UNDERWRITERS INC 3153-00 0023-00 3981-00 2574-00 1150-00 0024-00 2391-00 2316-00 2205-00 0025-00 0892-00 ST LOUIS ATLANTA BRENTWOOD LITTLEFIELD WAYNE RALEIGH GAINESVILLE BIRMINGHAM HOUSTON DALLAS METAIRIE MO GA TN TX NJ NC FL AL TX TX LA 63101 30329 37024 79339 07474 27602 32602 35216 77252 75231 70001 AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN EXCHANGE LIFE INSURANCE COMPANY FABRICS CO. FAMILY INSURANCE FAMILY LIFE ASSUR. CO. OF COLUMBUS FAVORITE CHICKEN CO.(SELF-INSURED) FEDERATIONS OF UNIONS-LOCAL 102 FIDELITY ASSURANCE CO. FOUNDERS LIFE INS. CO. FREIGHTWAYS (SELF-INSURED) GENERAL (DENTAL) GENERAL GROUP INSURANCE COMPANY GENERAL GROUP SERVICE GENERAL LIFE INS CO GENERAL LIFE INS CO GENERAL LIFE INS. CO. GENERAL LIFE INS. CO. OF DE GENERAL LIFE INS-CO GENERAL NATIONAL LIFE & ACCIDENT INS.CO. GROUP ADMINISTRATORS INSURANCE GUARANTY LIFE INS. CO. HEALTH AND ACCIDENT LIFE INS CO HEALTH AND LIFE INS. CO. HEALTH CARE DENTAL INSURANCE SYSTEMS INC HEALTH NETWORK 1328-00 1807-00 1584-00 0026-00 2695-00 0529-00 0027-00 0028-00 2428-00 3824-00 0839-00 1381-00 3877-00 3771-00 0029-00 0030-00 0029-01 1894-00 1556-00 0031-00 0724-00 0032-00 2099-00 2157-00 DALLAS BRIDGEPORT MADISON COLUMBUS ATLANTA PRAIRIEVILLE OKLAHOMA CITY AUSTIN HARRISON LAS VEGAS DALLAS JACKSONVILLE BRENTWOOD CLEARWATER HOUSTON HOUSTON NASHVILLE BOSTON HENDERSONVILLE PORTLAND ENNIS BALTIMORE NEW ORLEANS NASHVILLE TX CT WI GA GA LA OK TX AR NV TX FL TN FL TX TX TN MA TN OR TX MD LA TN 75221 06607 53704 31999 30302 70769 73125 78761 72602 89116 75266 32303 37024 33757 77001 77001 37250 02112 37077 97201 75119 21202 70179 37203 AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN HEALTH TRUST HERITAGE LIFE INCOME LIFE INS. CO. INSTITUTE OF ARCHITECTS - BENEFIT TRUST INS INSTITUTE OF MANAGEMENT SERVICES INSURANCE COMPANY OF TX INSURANCE CONSULTANTS INC INSURANCE GROUP P.A. INTEGRITY INSURANCE COMPANY INTERNATIONAL ADJUSTMENTS INS CO 1107-00 0033-00 0034-00 1459-00 0900-00 0035-00 1684-00 2885-00 0713-00 1067-00 P O BOX 9007 POST OFFICE BOX 49527 P O BOX 5008 P O BOX 512 P O BOX 509 20 EAST MARTIN STREET P O BOX 5309 P O BOX 20787 P O BOX 2465 10300 N CENTRAL EXP 4621 W NAPOLEON AVE SUITE 300 P O BOX 1530 1069 CONNECTICUT AVE 3099 EAST WASHINGTON AVE 1932 WYNNTON RD 6 CONCORD PKWY P O BOX 1002 POST OFFICE BOX 25523 6937 N INTERREGIONAL HWY P O BOX 840 P O BOX 43119 PO BOX 660238 P O BOX 2568 P O BOX 1188 P O BOX 10845 POST OFFICE BOX 1931 POST OFFICE BOX 3247 AMER GEN CEN -NASHVILLE P O BOX 105 ESSEX STATI P O BOX 1349 1433 S. W. 6TH AVENUE P O BOX 490 300 ST. PAUL PLACE P O BOX 791120 3322 WEST END AVE SUITE 775 P O BOX 899 1776 AMERICAN HERITAGE DR POST OFFICE BOX 208 400 LOCUST PO BOX 11107 110 W 7TH ST P O BOX 6011 P O BOX 16725 2 PENN CENTER PLAZA SUITE 1752 601 POYDRAS ST 102 MAIDEN LANE POST OFFICE BOX 2039 4962 FLORIDA BLVD. SUITE 302 CLEARWATER JACKSONVILLE WACO DES MOINES WINSTON-SALEM FORT WORTH SHERMAN OAKS JACKSON PHILADELPHIA NEW ORLEANS FL FL TX IA NC TX CA MS PA LA 33517 32224 76703 50398 27116 76102 91413 39236 19102 70130 NEW YORK TOPEKA BATON ROUGE NY KS LA 10270 66601 70821 AMERICAN INTERNATIONAL LIFE ASSUR. CO. OF NY AMERICAN INVERSTORS LIFE INS. CO., INC. AMERICAN LIBERTY LIFE INS. CO. 0036-00 0037-00 0038-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 6 TPL CARRIER FILE LISTING CARRIER NAME AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN LIFE LIFE LIFE LIFE LIFE LIFE AND ACCIDENT INSURANCE COMPANY AND CASUALTY INS. CO. AND HEALTH ASSURANCE CORP., THE ASSURANCE OF COLUMBUS CARE AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN LIFE INSURANCE COMPANY LIFE INSURANCE COMPANY OF NEW YORK LIFE PENSION HEALTH ASSOC LIFECARE LIFECARE MARITIME OFFICERS MEDICAL PLAN MARITIME OFFICERS MEDICAL PLAN MEDICAL ASSOC INSURANCE CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP 0957-00 0040-00 2162-00 0039-00 1557-00 2628-00 P O BOX 1600 207 FIFTH STREET NORTH P O BOX 3680 7 CLAYTON STREET 1932 WYNNTON RD 1100 POYDRAS ST SUITE 2600 208 SOUTH LASALLE STREET 810 SEVENTH AVENUE P O BOX 14786 P O BOX 1449 P O BOX 1449 P O BOX 35 P O BOX 35 200 N LASALLE STE 400 BENEFIT TRUST AMI P O BOX 2178 P O BOX 1353 P O BOX 19032 P O BOX 6960 ONE MOODY PLAZA 17TH FLOOR P O BOX 696520 P O BOX 7100 AMERICAN PATRIOT HEALTH SERVICE CENTER P O BOX 130 POST OFFICE BOX 3509 P O BOX 3279 4888 LOOP CENTRAL DR SUITE 700 WOODWYNDS PROFESSIONAL BUILDING, ROUTE 6 PO BOX 1068 1560 WILSON BLVD SUITE 1000 BOX 925 BOX 21627 P O BOX 2876 4725 N SCOTTSDALE RD SUITE 351 POST OFFICE BOS 10 1722 SOUTH CARSON P O BOX 300100 POST OFFICE BOX 2341 P O BOX 428 800 ROOSEVELT ROAD BLDG E,STE 200 P O BOX 61140 P O BOX 61140 DALLAS FARGO LAGUNA MONTGOMERY COLUMBUS NEW ORLEANS TX ND CA AL GA LA 75221 58102 92654 36104 31999 70163 CHICAGO NEW YORK BATON ROUGE GODDLETTSVILLE GOODLETTSVILLE DANIA DANIA CHICAGO IL NY LA TN TN FL FL IL 60604 10019 70898 37070 37370 33004 33004 60601 COSTA MESA CA 92628 CHICAGO GREEN BAY METAIRIE GALVESTON IL WI LA TX 60690 54307 70006 77550 SAN ANTONIO SHREVEPORT TREVOSE TX LA PA 78269 71134 19094 PENSACOLA ORLANDO SILVER SPRING HOUSTON FL FL MD TX 32591 32802 20918 77081 BREWSTER NY 10505 HATTIESBURG ARLINGTON MS VA 39401 22209 JACKSON COLUMBIA MILWAUKEE SCOTTSDALE MS SC WI AZ 39205 29221 53201 85251 DES MOINES TULSA AUSTIN SAN ANTONIO DELHI GLEN ELLYN IA OK TX TX LA IL 50301 74119 78755 78206 71232 60137 HARRISONBURG HARRISBURG PA PA 17106 17106 1510-00 1583-00 1413-00 3487-00 3486-00 2796-00 2787-00 2864-00 AMERICAN MEDICAL INTERNATIONAL EMPLOYEE 1266-00 AMERICAN AMERICAN AMERICAN AMERICAN 3767-00 1946-00 1575-00 0041-00 MEDICAL LIFE MEDICAL SECURITY NATIONAL AGENCY NATIONAL INS. CO. AMERICAN NATIONAL LIFE INS CO AMERICAN OIL FIELD DIVER'S INC AMERICAN PATRIOT HEALTH INS. CO. 3820-00 2369-00 0042-00 AMERICAN AMERICAN AMERICAN AMERICAN 3695-00 0043-00 0706-00 H277-50 PIONEER PIONEER LIFE INS. CO. POSTAL WORKERS UNION PROGRESSIVE AMERICAN PROGRESSIVE LIFE & HEALTH INS. CO. OF NY 0044-00 AMERICAN PROTECTIVE LIFE INSURANCE COMPANY AMERICAN PSYCHMANAGEMENT INC 0942-00 2389-00 AMERICAN AMERICAN AMERICAN AMERICAN PUBLIC LIFE INS. CO. PULPWOOD ASSOCIATION PUMP CO., INC RADIO ASSOCIATION WELFARE PLAN 0045-00 1019-00 1719-00 2300-00 AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN REBUBLIC INS. CO. RESERVE LIFE INS. CO. RETIREMENT LIFE INS CO SECURITY LIFE INS. CO. SEED TRADE ASSOCIATION BENEFITS SELFCARE CORPORATION 0046-00 1518-00 3992-00 0047-00 1870-00 2349-00 AMERICAN SENTINEL AMERICAN SENTINEL INS CO 3475-00 3540-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 7 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN AMERICAN 0776-00 3449-00 0048-00 1038-00 1563-00 3325-00 1004-00 2219-00 1274-00 1415-00 2043-00 0049-00 0050-00 1826-00 300 BAILEY P O BOX 459 POST OFFICE BOX 1746 PO BOX 15885 P O BOX 1636 P O BOX 26103 P O BOX 1628 P O BOX 1791 1800 STREET ROAD P O BOX 87 P O BOX 29683 5217 ROSS AVENUE POST OFFICE BOX 190-B HEALTH & LIFE INS 55E JACKSON BLVD 8TH FL. 425 AUSTIN AVENUE P O BOX 922043 P O BOX 5220 P O BOX 33757 505 S LENOLA RD SUITE 231 3850 N CAUSEWAY BLVD STE 1160 3850 N CAUSEWAY BLVD STE 1160 22 CENTURY BLVD P O BOX 21545 720 BLAIR MIL ROAD 22500 METROPOLITAN PKWY STE 100 P O BOX 82520 P O BOX 61010 P O BOX 3000 1650 LOS GAMOS DR 650 POYDRAS ST SUITE 1900 P O BOX 2178-E P O BOX 200579 306 S. 15TH STREET P O BOX 2187 P O BOX 34680 MEDICAL P O BOX 34680 DENTAL P O BOX 606 7417 N PETERS P O BOX 945260 POST OFFICE BOX 5025 FONDREN STATION 341 PONCE DE LOON AVE NE P O BOX 1086 CORPORATE CENTRE 1949 E SUNSHINE RT 1 BOX E-W FORT WORTH ROANOKE ENID WEST PALM BEACH INDIANAPOLIS OVERLAND PARK HUMBLE WILMINGTON WARRINGTON SHAWNEE MISSION DALLAS DALLAS INDIANAPOLIS CHICAGO TX IN OK FL IN KS TX DE PA KS TX TX IN IL 76107 46783 73701 33406 46206 66225 77347 19899 18976 66201 75229 75206 46206 60604 WACO HOUSTON KINGSTON INDIANAPOLIS MOORESTOWN TX TX NY IN NJ 76703 77292 12402 46203 08057 METAIRIE LA 70002 METAIRIE LA 70002 NASHVILLE EAGEN HORSHAM CLINTON TOWNSHIP TN MN PA MI 37214 55121 19044 48035 LINCOLN VIRGINIA BEACH MONTEREY PK SAN RAFAEL NEW ORLEANS COSTA MESA AUSTIN OMAHA CLIFTON LOUISVILLE NE VA LA CA LA CA TX NE NJ KY 68501 23466 91754 94903 70130 92628 78720 68102 07015 40232 NEVERSINK ARABI MAITLAND JACKSON NY LA FL MS 12765 70032 32794 39216 ATLANTA ST. LOUIS SPRINGFIELD GA MO MO 30365 63188 65899 HAYNESVILLE LA 71038 SERVICES SPECIALTY STANDARD LIFE AND ACCIDENT INS. CO. STATE INSURANCE STATE INSURANCE CO STERLING INSURANCE CO TEACHERS LIFE INS CO TRANSPORTATION SERVICE INCORPORATED TRAVELERS LIFE INSURANCE COMPANY TRUST ADMINISTRATORS INC UNDERWRITERS LIFE INSURANCE COMPANY UNION LIFE INS. CO. UNITED LIFE INS. CO. VETERINARY MEDICAL ASSOCIATION GROUP AMERICAN-AMICABLE LIFE INS. CO. AMERICAS CHOICE HEALTHPLANS AMERICHOICE SECURE PLUS AMERICORPS AMERICORPS BENEFITS 0016-00 3244-00 H338-70 3189-00 3804-00 AMERIGROUP OF LOUISIANA 9999-92 AMERIGROUP OF LOUISIANA INTEREST PAYMENTS INT9-92 AMERIGROUP TENNESSEE INC AMERIHEALTH ADMINISTRATORS AMERIHEALTH ADMINISTRATORS AMERIPLAN INC 3836-00 3964-00 3193-00 3206-00 AMERITAS LIFE INSURANCE CORP AMERIVANTAGE MEDICARE PLAN AMERRON MEDICAL DENTAL PLAN AMEX LIFE ASSURANCE COMPANY AMI CHOICE PLUS AMI SOUTH COAST CLAIMS AMIL INTERNATIONAL AMOCO LIFE INS. CO. AMPCO PITTSBORGH CORP NATL PRESCRIPTION ADM. AMRE INC HEALTH BENEFITS PROGRAM 2110-00 H589-60 1595-00 2173-00 1788-00 0991-00 3241-00 0051-00 2683-00 1773-00 AMS INSURANCE PLANS AMSTAR SUGAR CORPORATION ANCHOR BENEFITS CONSULTANT ANDREW JACKSON LIFE INS. CO., THE 2431-00 2019-00 2910-00 0052-00 ANNUITIES AND RELIEF ANNUITY BOARD OF THE SOUTHERN BAPTIST CONVENTION ANPAC LOUISIANA INSURANCE COMPANY 0752-00 1236-00 3629-00 ANSELL-EDMONT 2393-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 8 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP ANTHEM AMERICAN HEALTH NETWORK ANTHEM AVONDALE REPRESENTED PPO ANTHEM HEALTH & LIFE INSURANCE ANTHEM LIFE INSURANCE CO. OF IN. ANTHEM STANDARD PPO ANTHONY ACTIVE MEDICAL AON SELECT INC APA PARTNERS INC 2513-00 3791-00 1857-00 2050-00 3538-00 2617-00 3029-00 3076-00 DALLAS LOS ANGELES PISCATAWAY INDIANAPOLIS CLEVELAND OMAHA HORSHAM LATHAM TX CA NJ IN OH NE PA NY 75265 90060 08855 46206 44125 68103 19044 12110 APEX HEALTHCARE APICAL HEALTH SOLUTIONS APPALACHIAN BENEFIT ADMINISTRATORS APPALACHINA NATIONAL LIFE INS. CO. APS HEALTHCARE APWU ARCADIAN COMMUNITY CARE ARCADIAN HEALTH PLAN ARCHDI0CESE OF NEW ORLEANS RELIGIOUS HEALTH PLAN ARETHUSA (SELF-INSURED) 2752-00 3203-00 3760-00 0053-00 3224-00 3745-00 3584-00 H570-00 1601-00 2483-00 BIRMINGHAM LAS VEGAS WAYNESVILLE KNOXVILLE ROCKVILLE GLEN BURNIE SHREVEPORT COVINA NEW ORLEANS HOUSTON AL NV NC TN MD MD LA CA LA TX 35238 89193 28786 37901 20849 21060 71106 91723 70114 77002 ARGIS EMPLOYEE BENEFIT PLAN TRUST ARGIS INCORPORATED ARGUS ARGUS ARGUS ARIES MARINE CORPORATION ARK-LA-MISS LABORERS WELFARE FUND ARKANSAS FREIGHTWAYS 1168-00 1134-00 3414-00 3388-00 3387-00 3276-00 2190-00 1534-00 LITTLE ROCK WINNSBORO KANSA CITY KANSA CITY SCRANTON LAFAYETTE METAIRIE OVERLAND PARK AR LA MO MO PA LA LA KS 72203 71295 64141 64141 18505 70505 70001 66212 ARKANSAS MANAGED CARE ORGANIZATION ARKANSAS MUNICIPAL LEAUGE ARKANSAS RETAIL GROCERS INSURANCE SERVICES ARKLA GAS CO ARMOUR LIFE INS. CO. ARMSTRONG MEDICAL CARE & DENTAL ASSISTANCE PLANS 2902-00 0815-00 1273-00 0930-00 0054-00 1963-00 LITTLE ROCK CROSSETT DALLAS SHREVEPORT KANSAS CITY GREENVILLE AR AR TX LA MO SC 72221 71635 75380 71151 64141 29662 ARROW TRUCKING CO GROUP HEALTH PLAN ARS BENEFITS INC ASBESTOS LOCAL #53 WELFARE PLAN ASBESTOS WORKERS LOCAL #21 ASCO-U. S. ASHLAND OIL EMPLOYEE MEDICAL PLAN ASMR CORP 2913-00 2154-00 1202-00 1993-00 3175-00 0704-00 3359-00 TULSA SMYRNA METAIRIE DALLAS HOUSTON LEXINGTON MOORESTOWN OK GA LA TX TX KY NJ 74101 30081 70002 75229 77024 40512 08057 ASPLUNDH TREE EXPERT CO ASRM CORP 1744-00 3320-00 WILLOW GROVE MOORESTOWN PA NJ 19090 08057 ASSOCIATED ASSOCIATED ASSOCIATED ASSOCIATED 0903-00 0055-00 1892-00 0730-00 P O BOX 650342 P O BOX 60007 P O BOX 6880 P O BOX 6146 8333 ROCKSIDE RD P O BOX 3039 110 GIBRALTAR ROAD 8 BRITISH AMERICAN BLVD P O BOX 1506 P O BOX 381173 P O BOX 95638 P O BOX 780 POST OFFICE BOX 2647 P O BOX 1246 P O BOX 1358 920 PIERREMONT RD/STE 506 P O BOX 4946 1529 NEWTON ST 600 TRAVIS SUITE 160 P O BOX 3627 204 FAIR AVENUE P O BOX 419019 P O BOX 419019 P O BOX 3598 P O DRAWER 51789 4200 S I-10 SERV RD, #134 C/O LA HOOD & ASSOCIATES P O BOX 12170 P O BOX 22118 P O BOX 338 P O BOX 802516 PO BOX 21734 POST OFFICE BOX 19089 ARMSTRONG WORLD IND. INC P O BOX 5515 P O BOX 3097 P O BOX 1553 2540 SEVERN SUITE 206 11580 REEDER RD 314 NORTH POST OAK LANE P O BOX 14000 509 S LENOLA RD BLDG 2 BLAIR MILL ROAD 509 S LENOLA RD BLDG #2 2210 NORTH MAIN POST OFFICE BOX 10487 3855 PRESIDENTIAL PARKWAY P O BOX 31045 NORTH LITTLE ROCK BIRMINGHAM ATLANTA BIRMINGHAM AR AL GA AL 72114 35202 30340 35222 BUILDERS & CONTRACTORS OF ARKANSAS DOCTORS HEALTH AND LIFE INS. CO. GENERAL CONTRACTORS OF AMERICA GROUP SERVICE INC LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 9 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP ASSOCIATED HEALTH ADMINISTRATORS ASSOCIATED HEALTH PLANS OF LA. 1590-00 0816-00 MOBILE METAIRIE AL LA 36616 70001 ASSOCIATED PRESCRIPTION SERVICES ASSOCIATED RESOURCES MANAGEMENT INC ASSOCIATED RISK SERVICES ASSOCIATED TIRE DEALERS ASSOCIATION ASSOCIATES LIFE INS. CO. ASSOCIATION & SOCIETY INSURANCE CORPORATION ASSOCIATION BENEFIT PLAN 1316-00 3006-00 2198-00 0842-00 0056-00 2394-00 3265-00 BALTIMORE MONROE SMYRNA LEEDS INDIANAPOLIS ROCKVILLE WASHINGTON MD LA GA AL IN MA DC 21207 71201 30081 35094 46208 20852 20415 ASSOCIATION INSURANCE SERVICES INC ASSOCIATION LIFE INS. CO., INC. ASSOCIATIONS COMBINED TRUST 2270-00 0057-00 1035-00 SHAWANEE MISSION MILWAUKEE DALLAS KS WI TX 70886 53203 75240 ASSUMPTION PARISH POLICE JURY EMPLOYEE 2014-00 NAPOLEONVILLE LA 70390 ASSURANT EMPLOYEE BENEFITS ASSURANT HEALTH ASSURANT HEALTH ASSURANT HEALTH ASSURANT HEALTH ASSURANT HEALTH ACCESS ASSURE CARE 3450-00 3317-00 3816-00 3758-00 3473-00 4001-00 3056-00 CLINTON HAZELWOOD MILWAUKEE CLINTON EL PASO PHOENIX PLYMOUTH IA MO WI IA TX AZ MN 52733 63042 53201 52733 79998 85072 55441 ASSURITY LIFE INSURANCE ATA DAVIS GARVIN AGENCY ATALS LIFE INSURANCE COMPANY ATHENS LIFE INSURANCE ATLANTA LIFE INS. CO. ATLANTIC & PACIFIC LIFE INS. CO. OF AMERICA ATLANTIC AMERICAN LIFE INS. CO. ATLANTIC ENVELOPE COMPANY 3302-00 0797-00 0718-00 2581-00 0058-00 0060-00 0059-00 2715-00 LINCOLN COLUMBIA DONALDSONVILLE INDIANAPOLIS ATLANTA ATLANTA ATLANTA NEW ORLEANS NE SC LA IN GA GA GA LA 68501 29221 70346 46206 30303 30329 30319 70126 ATLANTIC HOME TRUST ATLANTIC RICHARD CORP.(SELF INSURED) ATLANTIC SOUTHERN INS CO ATLANTICARE HEALTH PLANS ATLAS ADMINISTRATORS ATTA ADMINISTRATORS AUDUBON LIFE INS. CO. AUGUST INTERNATIONAL 2130-00 1122-00 2355-00 3250-00 2940-00 1184-00 0061-00 1754-00 PISCATAWAY PASADENA SAN JUAN MAMMONTON DALLAS BOISE BATON ROUGE DALLAS NJ CA PR NJ TX ID LA TX 08855 91109 00930 08037 75380 83705 70821 75206 AULTCARE AULTRA ADMINISTRATIVE GROUP AUSTIN & MERRITT AUSTIN INDUSTRIES-HUMAN RESOURCES DEPT AUTO MACHINIST HEALTH & WELFARE FUND AUTO ZONE BENEFITS 3479-00 3443-00 1280-00 1147-00 2210-00 1594-00 CANTON CANTON PORT CHESTER DALLAS SEATTLE MEMPHIS OH OH NY TX WA TN 44706 44735 10573 75221 98124 38111 AUTOMOTIVE BENEFITS SERVICES 1862-00 P O BOX 160184 3636 S I-10 SERVICE RD #204 2811 LORD BALTIMORE DR 1101 N 3RD ST P O BOX 1553 PO BOX 545 3333 N MERIDIAN ST P O BOX 2510 OFFICE OF PERSONNEL MGMT 1900 E STREET NW P O BOX 23099 735 NORTH SECOND STREET 13601 PRESTON RD SUITE 201E, LOCK BOX 108 HEALTH BENEFIT FUND P O BOX 518 P O BOX 2940 P O BOX 42033 P O BOX 624 P O BOX 2806 P O BOX 981602 P O BOX 52136 13700 WATERTOWER CIRCLE SUITE D P O BOX 82533 P O BOX 21627 110 RAILROAD AVENUE P O BOX 6146 100 AUBURN AVENUE, N.E. POST OFFICE BOX 49586 POST OFFICE BOX 10072 132 B HARBOR CIRCLE NEW ORLEANS EAST BRANCH P O BOX 1362 P O BOX 7077 P O BOX 362889 P O BOX 613 P O BOX 801234 BOX GG POST OFFICE BOX 2547 5910 N CENTRAL EXPRESSWAY SUITE 400 P O BOX 6910 P O BOX 35276 P O BOX 1391 P O BOX 1590 P O BOX C34203 3030 POPLAR AVENUE DEPT 8204-2 P O BOX 42043 HOUSTON TX 77242 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 10 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP AUXIANT 3936-00 CEDAR RAPIDS IA 52401 AV MED AV MED OF LOUISIANA 3893-00 0988-00 MIAMI METAIRIE FL LA 33156 70002 AVESIS AVMA GROUP HEALTH & LIFE AVON GROUP INS PROGRAM AVONDALE INDUSTRIES (SELF INSURED) AVOYELLES WHOLESALE GROCERY AVOYELLES WHOLESALE LTD B & C HEALTH BENEFITS B A A I B.E.AND K INC 3890-00 3281-00 0891-00 1716-00 1110-00 1034-00 2947-00 2377-00 2801-00 PHOENIX CHICAGO SPRINGFIELD NEW ORLEANS ALEXANDRIA ALEXANDRIA KENSINGTON SIOUX CITY SPARTANBURG AZ IL MA LA LA LA MD IA SC 85011 60690 01101 70150 71301 71335 20895 51102 29306 B'NAI BOITH MEMBERS INSURANCE PROGRAM BAC LOCAL #2 ALBANY 2168-00 2734-00 MCLEAN ALBANY VA NY 22102 12206 BAKERY & CONFECTIONARY UNION BALDOR INSURANCE 1345-00 2482-00 KENSINGTON FT SMITH MD AR 20895 72902 BALL-INCON (SELF-INSURED) BANCROFT BAG (SELF-FUNDED) BANKER'S TRUST CO BANKERS COMMERCIAL LIFE INS. CO. BANKERS FIDELITY LIFE INS. CO. BANKERS INSURANCE CO. FJUA BANKERS LIFE AND CASUALTY BANKERS LIFE AND CASUALTY BANKERS LIFE COMPANY BANKERS LIFE INS. CO. OF NE BANKERS MUTIPLE LINE INS. CO. BANKERS SECURITY LIFE INS. SOCIETY BANKERS UNITED LIFE ASSURANCE CO. BANNER LIFE INS. CO. BAPTIST HEALTH SERVICES GROUP BARNES AND NOBLE,INC BAROID (SELF-INSURED) BAS LTD BASF CORPORATION BASIC BENEFITS GROUP BATON ROUGE ROOFING & SHEET METAL ROOFERS 317 BATON ROUGE ROOFING & SHEET METAL ROOFERS 317 BAXTER HEALTH LINE BAY OAKS HEALTH PLAN BCS LIFE INS. CO. BEALL-LADYMON CORPORTATION BEAUREGARD ELECTRIC (SELF-INSURED) BEAZER WEST INC INSURANCE DEPARTMENT BECKER INDUSTRIES BECKWITH, HIGHTOWER & REMBERG 2265-00 2260-00 1823-00 0063-00 0064-00 1761-00 0065-00 3812-00 0066-00 0067-00 0068-00 0069-00 0070-00 0071-00 2871-00 2183-00 1600-00 3260-00 2055-00 1698-00 1094-00 1042-00 1678-00 3309-00 0062-00 1555-00 2653-00 2056-00 0959-00 2950-00 225 2ND ST SE SUITE 500 9400 SOUTH DADELAND BLVD 2900 RIDGELAKE DRIVE SUITE 440 P O BOX 7777 P O BOX 909720 P O BOX 9004 P O BOX 50280 3015 BROADWAY BOX 5725 10401 CONNECTICUT AVE P O BOX 9900 145 N CHURCH ST SUITE 300 P O BOX 1030 NY HEALTH BENEFIT FUND 8 RUSSELL ROAD 10401 CONNECTICUT AVENUE 5711 S 7TH P O BOX 2400 P O DRAWER 789 P O BOX 70100 WALL ST 5720 LBJ FREEWAY POST OFFICE BOX 10245 P O BOX 33023 P O BOX 66927 P O BOX 1935 711 HIGH STREET COTNER AT "O" STREET 4810 N. KENNETH AVENUE 1701 PENNSYLVANIA AVE N W POST OFFICE BOX 1447 1701 RESEARCH BLVD. P O BOX 249 P O BOX 833823 DEPT 198 P O BOX 62107 P O BOX 14208 P O BOX 33168 P O BOX 758 2061 BEAUMONT DR 2061 BEAUMONT DR P O BOX 26986 424 N TARPAY ROAD 676 NORTH ST. CLAIR P O BOX 5756 P O DRAWER 970 P O BOX 190999 P O BOX 30 NPPN P O BOX 5095 RUSTON SHREVEPORT NEW YORK DALLAS ATLANTA SAINT PETERSBURG CHICAGO CARMEL DES MOINES LINCOLN CHICAGO WASHINGTON CEDAR RAPIDS ROCKVILLE STAMPS RICHARDSON HOUSTON JACKSON DETROIT DENHAM SPRINGS BATON ROUGE BATON ROUGE MILWAUKEE TEXAS CITY CHICAGO SHREVEPORT DERIDDER DALLAS HAHNVILLE MIDDLETOWN LA LA NY TX GA FL IL IN IA NE IL DC IA MA AR TX TX MS MI LA LA LA WI TX IL LA LA TX LA NY 71273 71137 10005 75240 30319 33733 60666 46082 50307 68501 60630 20006 52406 20850 71860 75083 77205 39236 48232 70727 70806 70806 53226 77591 60611 71135 70634 75219 70057 10940 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 11 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP BEECH STREET BEECH STREET BEHAVIORAL HEALTH INC 1348-00 3752-00 2955-00 IRVINE RICHARDSON BATON ROUGE CA TX LA 92713 75085 70808 BEHAVIORAL HEALTH SYSTEMS BELL DEDICATED SERVICE CENTER BELL NATIONAL LIFE INS. CO. BELMONT CONSTRUCTORS INC BEN-A-MED BENE PLAN STRATEGIES BENE-PRO BENEFIT AND MANAGED CARE PROFESSIONALS BENEFICE BENEFICIAL ASSOCIATION OF CONGRESSIONAL EMPLOYEES BENEFICIAL EMPLOYEES SECURITY TRUST BENEFICIAL LIFE INS. CO. 3779-00 1701-00 0072-00 2399-00 1618-00 1838-00 2452-00 3075-00 2458-00 2843-00 0073-00 BIRMINGHAM BIRMINGHAM GAITHERSBURG JACKSON WEST MONROE DAYTON PLYMOUTH PISCATAWAY VIENNA NEWPORT BEACH SALT LAKE CITY AL AL MD MN LA OH MN NJ VA CA UT 35283 35283 20760 56143 71291 45401 55441 08854 22183 92658 84136 BENEFICIAL STANDARD LIFE INS. CO. BENEFIT ADMIN. SYSTEMS LTD.IGA GRP. EMP.BENEFIT PROG. BENEFIT ADMINISTRATION SERVICES BENEFIT ADMINISTRATION SERVICES BENEFIT ADMINISTRATION SERVICES,LTD BENEFIT ADMINISTRATIVE SYSTEMS, LLC BENEFIT ADMINISTRATORS BENEFIT ADMINISTRATORS OF AMERICA BENEFIT AMERICA BENEFIT CLAIMS ADMINISTRATORS INC BENEFIT CLAIMS PAYORS INC BENEFIT CONCEPTS INC BENEFIT CONTROL SERVICE CORP BENEFIT COORDINATORS CORP 0074-00 1759-00 3860-00 3644-00 0868-00 3512-00 1937-00 1195-00 1539-00 1286-00 2443-00 2331-00 1281-00 3261-00 AMARILLO ORLAND PARK EAGEN RICHLAND JACKSON HOMEWOOD FORT MITCHELL DES MOINES TIFTON TOLEDO PHOENIX VALHALLA DENHAM SPRINGS PITTSBURGH TX IL MN MS MS IL KY IA GA OH AZ NY LA PA 79105 60462 55121 39157 39236 60430 41017 50306 31793 43603 85069 10595 70726 15205 BENEFIT DATA ADMINISTRATORS BENEFIT DESIGN & ADMINISTRATORS INC FOR WABASH 2346-00 1751-00 LARKSPUR INDIANAPOLIS CA IN 94977 46256 BENEFIT INNOVATIONS LTD BENEFIT MANAGEMENT INC 2969-00 1869-00 PEORIA JOPLIN IL MO 61612 64803 BENEFIT MANAGEMENT SERVICES 3902-00 RIDGELAND MS 39157 BENEFIT BENEFIT BENEFIT BENEFIT BENEFIT BENEFIT BENEFIT MANAGEMENT SERVICES MANAGEMENT SYSTEM PAYROLL SYSTEM PLAN ADMINISTRATORS PLAN SERVICES PLANNERS RESOURCES ADMINISTRATIVE SERVICES INC 1321-00 3323-00 2042-00 1489-00 2297-00 1017-00 2350-00 BATON ROUGE MADISON SAN ANTONIO TYLER SHREVEPORT SAN ANTONIO METAIRIE LA MS TX TX LA TX LA 70898 39130 78216 75713 71135 78269 70001 BENEFIT BENEFIT BENEFIT BENEFIT SERVICES INC SUPPORT INC SYSTEMS TRUST LIFE INS. CO. 3099-00 3322-00 2583-00 0075-00 P O BOX 16609 P O BOX 853925 2431 S ACADIAN THRUWAY STE 500 P O BOX 830724 P O BOX 830279 702 RUSSELL AVENUE 146 INDUSTRIAL PARK 410 WASHINGTON P O BOX 1391 10405 6TH AVE NORTH #300 242 OLD NEW BROWNSWICK RD P O BOX 6000 P O BOX 3100 36 SOUTH STATE STREET BENEFICIAL LIFE TOWER P O BOX 15047 43 ORLAND SQ. 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BIG LOTS ASSOCIATE BENEFIT PLAN BILL'S DOLLAR STORES MEDICAL BENEFITS BLAIR MILL INTERCOUNTY HEALTH PLAN BLESSEY ENTERPRISES BLLINGER SHIPYARD EMPLOYEE HEALTH CARE BLOSSMAN INC BLUE ADVATAGE ADMINISTRATION OF AR BLUE BEACON INTERNATIONAL INC BLUE BELL BENEFITS TRUST BLUE CARE NETWORK BLUE CHOICE BLUE CIRCLE DENTAL BENEFITS PLAN 2234-00 3169-00 2416-00 0076-00 1921-00 0077-00 0030-13 3013-00 3222-00 2442-00 2511-00 3201-00 2192-00 2945-00 3312-00 2213-00 2263-00 3506-00 3114-00 1832-00 2770-00 3032-00 2887-00 BLUE BLUE BLUE BLUE BLUE BLUE BLUE 3797-00 3718-00 3652-00 4006-00 3610-00 3740-00 3463-00 CROSS CROSS CROSS CROSS CROSS CROSS CROSS (REGENCE GROUP ADMIN) & BLUE SHIELD OF NEBRASK BLUE SHIELD OF GA BLUE SHIELD OF GEORGIA CALIFORNIA (ANTHEM) FEB (ANTHEM) OF ALABAMA BLUE CROSS OF ALABAMA BLUE CROSS OF ALABAMA 3876-00 0508-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 13 TPL CARRIER FILE LISTING CARRIER NAME BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF ALASKA (PREMERA) ARIZONA ARKANSAS ARKANSAS (FEP ARKANSAS (MED REPL) ARKANSAS (WALMART) CALIFORNIA CALIFORNIA CALIFORNIA (ANTHEM) CALIFORNIA (ANTHEM) CALIFORNIA (MED REPL) COLORADO COLORADO (ANTHEM DENVER) CONNECTICUT DELAWARE FLORIDA GEORGIA GEORGIA (FEP) GREATER PHILADELPHIA HAWAII IDAHO ILLINOIS ILLINOIS ILLINOIS (CHICAGO) ILLINOIS (DENTAL) INDIANA IOWA IOWA (WELLMARK) KANSAS KANSAS (BOEING) KENTUCKY KENTUCKY (ANTHEM) KENTUCKY (ANTHEM) KENTUCKY (ANTHEM) LOUISIANA LOUISIANA LOUISIANA (FEP) MAINE MARYLAND MASSACHUSETTS MASSACHUSETTS MICHIGAN MICHIGAN (MED REPL) MINNESOTA MISSISSIPPI MISSOURI (ANTHEM) MISSOURI (ANTHEM) MISSOURI (ANTHEM) MISSOURI (KC) MISSOURI (ST LOUIS) MONTANA CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP 3756-00 0532-00 0548-00 3894-00 H584-90 3707-00 3693-00 3566-00 3558-00 3969-00 H056-40 0835-00 3708-00 1697-00 2888-00 0537-00 0979-00 3926-00 0541-00 1936-00 1234-00 0543-00 3583-00 0535-00 3840-00 0964-00 0539-00 3611-00 0837-00 2233-00 0540-00 3954-00 3732-00 3551-00 3681-00 0546-00 2601-00 1405-00 0542-00 0545-00 3742-00 0544-00 H231-90 1708-00 0515-00 1366-00 3503-00 3502-00 1251-00 0533-00 3971-00 P O BOX 240609 P O BOX 13466 P 0 BOX 2417 P O BOX 2181 P O BOX 2417 P O BOX 1460 P O BOX 60007 P O BOX 272610 P O BOX 60007 P O BOX 54139 P O BOX 60007 P O BOX 5368 P O BOX 5747 P O BOX 1042 P O BOX 1991 P O BOX 1798 P O BOX 7368 P O BOX 105557 1333 CHESTNUT ST. 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MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 14 TPL CARRIER FILE LISTING CARRIER NAME BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS OF OF OF OF OF OF OF OF OF OF OF OF OF MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW JERSEY (EXCELLUS) NEW JERSEY (MED REPL) NEW MEXICO NEW YORK NEW YORK (AT & T) NEW YORK (EMPIRE) NEW YORK (EXCELLUS) NEW YORK (NORTHEASTERN) CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP 2441-00 1402-00 2051-00 2672-00 0947-00 3451-00 H315-40 2916-00 0741-00 1836-00 0928-00 3809-00 0536-00 P O BOX 50004 P O BOX 3248 P O BOX 10330 3000 GOFFS FALLS RD PO BOX 420 165 COURT ST 3 PENN PLAZA P O BOX 27630 PO BOX 3850 GRAND CENTRAL 75 CRYSTAL RUN ROAD P O BOX 5069 P O BOX 22999 1251 NEW SCOTLAND ROAD P O BOX 8650 343 STATE ST 298 MAIN ST P O BOX 80 P O BOX 35 4510 13TH AVE SW P O BOX 182042 P O BOX 94754 9075 CENTRE POINT DRIVE SUITE 200 P O BOX 105187 P O BOX 943 1351 WILLIAM HOWARD TAFT P O BOX 3283 1215 SOUTH BOULDER P O BOX 1271 P O BOX 226 P O BOX 890713 2500 ALBERTINE AVE P O BOX 890062 P O BOX 3355 P O BOX 2085 1901 MARKET ST 70 N MAINE STREET PO BOX 890382 PO BOX 69352 P O BOX 1210 444 WESTMINSTER MALL 444 WESTMINSTER ST P O BOX 6000 P O BOX 100300 P O BOX 100121 I-20 EAST ALPINE ROAD P O BOX 100605 1601 WEST MADISON 801 PINE ST 1 CAMERON HILL CIR SUITE #0002 BUTTE OMAHA RENO MANCHESTER NEWARK ROCHESTER NEWARK ALBUQUERQUE NEW YORK MIDDLETON MIDDLETOWN ROCHESTER ALBANY MT NE NV NH NJ NY NJ NM NY NY NY NY NY 59701 68180 89520 03111 07101 14647 07105 87125 10017 10943 10940 14692 12208 ROCHESTER BUFFALO NY NY 14650 14240 DURHAM FARGO COLUMBUS CLEVELAND WESTCHESTER NC ND OH OH OH 27702 58121 43218 44101 45069 ATLANTA TOLEDO CINCINNATI TULSA TULSA PORTLAND PITTSBURGH CAMP HILL HARRISBURG CAMPHILL PITTSBURGH PITTSBURGH PHILADELPHIA WILKES-BARRE CAMP HILL HARRISBURG PITTSBURGH PROVIDENCE PROVIDENCE GREENVILLE COLUMBUS COLUMBUS COLUMBIA COLUMBIA SIOUX FALLS CHATTANOOGA CHATTANOOGA GA OH OH OK OK OR PA PA PA PA PA PA PA PA PA PA PA RI RI SC SC SC SC SC SD TN TN 30348 43656 45206 74102 74119 97207 15222 17089 17177 17089 15230 15230 19101 18711 17089 17106 15230 02901 02903 29606 29202 29201 29219 29260 57104 37402 37402 BLUE CROSS OF NEW YORK (ROCHESTER) BLUE CROSS OF NEW YORK (WESTERN) 1023-00 0746-00 BLUE BLUE BLUE BLUE BLUE CROSS CROSS CROSS CROSS CROSS OF OF OF OF OF NORTH CAROLINA NORTH DAKOTA OHIIO (CENTRAL) OHIO OHIO (ANTHEM) 1058-00 3181-00 1568-00 2693-00 3448-00 BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OF OHIO (ANTHEM) OHIO (NORTHWEST) OHIO (SOUTHWEST) OKLAHOMA OKLAHOMA OREGON PENNSYLVANIA PENNSYLVANIA PENNSYLVANIA PENNSYLVANIA (ANTHEM) PENNSYLVANIA (HGHMRK) PENNSYLVANIA (HGHMRK) PENNSYLVANIA (IND) PENNSYLVANIA (NORTH EAST) PENNSYLVANIA HIGHMARK PENNSYLVANIA HIGHMARK PENNSYLVANIA HIGHMARK RHODE ISLAND RHODE ISLAND (MEDICARE REPL) SOUTH CAROLINA SOUTH CAROLINA SOUTH CAROLINA SOUTH CAROLINA SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TENNESSEE 3993-00 0534-00 1163-00 3861-00 2691-00 1270-00 3907-00 1657-00 2081-00 3867-00 3498-00 3726-00 3481-00 1358-00 3986-00 3985-00 4003-00 1158-00 H415-20 3978-00 3976-00 3974-00 0968-00 3492-00 3145-00 0880-00 3950-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 15 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP BLUE CROSS OF TENNESSEE (MEMPHIS) BLUE CROSS OF TEXAS 0972-00 4002-00 MEMPHIS HOUSTON TN TX 38101 77027 BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE BLUE CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS CROSS OF OF OF OF OF OF OF OF OF OF OF OF OF 0520-00 3537-00 3680-00 3585-00 1818-00 2856-00 1006-00 1276-00 2266-00 3672-00 1196-00 0742-00 1432-00 DALLAS DALLAS RICHARDSON SAN ANTONIO SALT LAKE CITY MONTPELIER RICHMOND SEATTLE TACOMA SEATTLE SEATTLE WASHINGTON VIENNA TX TX TX TX UT VT VA WA WA WA WA DC WV 75265 75266 75080 78272 84130 05601 23279 98111 98402 98111 98111 20224 26105 BLUE BLUE BLUE BLUE BLUE BLUE CROSS CROSS CROSS CROSS CROSS CROSS OF WISCONSIN OF WISCONSIN (ANTHEM) OF WISCONSIN (ANTHEM) OF WV(MOUNTAIN ST) OF WYOMING OKLAHOMA 0740-00 3998-00 3895-00 3874-00 1190-00 0521-00 MILWAUKEE WAUKESHA ATLANTA WHEELING CHEYENNE TULSA WI WI GA WV WY OK 53201 53188 30348 26003 82001 74102 BLUE CROSS PENNSYLVANIA (WESTERN) BLUE SHIELD OF PUERTO RICO BLUEBONNET ADMINISTRATORS BMA-DAIRYMEN INC BMI-HEALTH PLANS BO LLINGER EMPLOYEE HEALTH CARE PLAN BOA EMPLOYEE BENEFITS BOILERMAKERS NATIONAL HEALTH & WELFARE FUND 0538-00 2822-00 1677-00 1953-00 3096-00 1713-00 1508-00 0874-00 PITTSBURGH SAN JUAN BATON ROUGE KANSAS CITY BARTLESVILLE LOCKPORT COLUMBUS KANSAS CITY PA PR LA MO OK LA OH KS 15230 00936 70898 64141 74006 70374 43220 66101 BOISE CASCADE CORP BOLLINGER EMPLOYEES HEALTH PLAN BOLLINGER EMPLOYEES HEALTHCARE PLAN BOLLINGER EMPLOYEES HEALTHCARE PLAN BOON CHAPMAN BORAL BRICKS INC BORDEN HEALTH CARE 1174-00 3849-00 3729-00 2264-00 0971-00 2510-00 0943-00 BOISE SHORT HILLS SHORT HILLS LOCKPORT AUSTIN AUGUSTUS COLUMBUS ID NJ NJ LA TX GA OH 83707 07078 07078 70374 87866 30913 43216 BORG-WARNER CHEMICALS,INC BOSSIER MEDICAL CENTER EMPLOYEE BENEFIT TRUST BOSSIER PARISH SCHOOL BOARD BOSTON MUTUAL LIFE INS. CO. BOYD BROTHERS TRANSPORTATIONS INC BOYD GAMING CORPORATION CENTRAL REGION EMPLOYEES 1300-00 1750-00 2138-00 0078-00 3226-00 2939-00 WAVELAND BOSSIER CITY BENTON CANTON CLAYTON LAS VEGAS MS LA LA MA AL NV 39576 71111 71006 02021 36016 89109 BOYS & GIRLS CLUB INSURANCE TRUST 2949-00 DES MOINES IA 50309 BRADFORD NATIONAL LIFE INS. CO. 0079-00 P O BOX 98 1800 WEST LOOP SOUTH 6TH FLOOR POST OFFICE BOX 225730 P O BOX 66044 901 S CENTRAL P O BOX 795180 P O BOX 30270 P O BOX 186 2015 STAPLES MILL RD P O BOX 91015 1114 BROADWAY PLAZA P O BOX 91059 P O BOX 327 550 12TH ST SW 811 GRAND CENTRAL AVE BOX 5556 401 W MICHIGAN STREET N17 W24340 RIVERWOOD DR P O BOX 105187 P O BOX 7026 P O BOX 2266 1215 SOUTH BOULDER P O BOX 3283 P O BOX 358. P O BOX 363628 P O BOX 98018 BOX 41948 2425 NOWATA PLACE P O BOX 250 P O BOX 20945 754 MINNESOTA AVE SUITE 522 P O BOX 61 P O BOX 727 P O BOX 706 P O BOX 250 P O BOX 9201 P O BOX 1957 ADMIN. SERVICES UNIT PO BOX 189 P O BOX N 2105 AIRLINE DR P O BOX 2000 120 ROYALL STREET P O BOX 70 BENEFIT PLAN 2950 INDUSTRIAL RD 100 COURT AVE SUITE 306 771 CORPORATE DRIVE STE. 201 LEXINGTON KY 40503 TEXAS TEXAS TEXAS TEXAS (ANTHEM) UTAH VERMONT VIRGINIA WASHINGTON (KING COUNTY MEDICAL) WASHINGTON (PIERCE COUNTY MEDICAL) WASHINGTON (PREMERA) WASHINGTON & ALASKA WASHINGTON DC WEST VIRGINIA LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 16 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP BRADLEY AND COKER BRAVO HEALTH BRAVO HEALTH BREAVELL CLAIMS MANAGEMENT BREMCO BRICKLAYERS LOCAL UNION NO.1 (SELF INSURED) BRIDGEFIELD CASUALTY INSURANCE CO BRIDGESTONE AMERICAS HOLDING INC BRISTOL-MYERS SQUIBB CARDIOVASCULAR ACCESS PROGRAM BROKERAGE CONCEPTS 2600-00 3690-00 H452-80 2459-00 0807-00 0955-00 3292-00 3188-00 2660-00 3931-00 LITTLE ROCK EL PASO EL PASO BROOKFIELD BOSSIER CITY NEW ORLEANS LAKELAND JAMESVILLE MCLEAN BLUE BELL AR TX TX WI LA LA FL WI VA PA 72221 79998 79998 53008 71111 70116 33802 53547 22102 19422 BROKERAGE CONCEPTS OF DELAWARE BROKERS NATIONAL LIFE INSURANCE COMPANY BROOKFIELD S.I.B.S. 3228-00 3024-00 1308-00 WARMINSTER HOUSTON PARK RIDGE PA TX IL 18974 77251 60068 BROOKSHIRE BROTHERS BROWN & BROWN INC BROWN AND ROOT INC BROWN FORMAN CORPORATION BROWN GROUP INSURANCE BROWNING AMBULANCE AND HEALTH SERVICES INC BROWNING FERRIS INDUSTRY (SELF-INSURED) BRUCE FOOD'S CORP MEDICAL BENEFITS TRUST BUCK EYE LIQUOR CO(SELF-INSURED) BUILDING TRADE ASSOCIATION HEALTH CARE PLAN 2069-00 3104-00 0926-00 2927-00 1244-00 0810-00 2038-00 1995-00 1257-00 2159-00 LUFKIN DAYTONA BEACH HOUSTON LOUISVILLE ST LOUIS DENHEM SPRINGS LAFAYETTE NEW IBERIA DALLAS FREMONT TX FL TX KY MO LA LA LA TX CA 75902 32115 77292 40201 63166 70726 70505 70562 75229 94538 BUNKIE BANK & TRUST CO., (SELF-INSURED) BUPA INTERNATIONAL 2001-00 3057-00 BUNKIE MIAMI LA FL 71322 33131 BURGER KING CORPORATION BURGETT & DIETRICH BURHAM SERVICE CORP EMPLOYEE HEALTH PLAN BURNS INTERNAT'L HEALTH & WELFARE FUND BUSINESS ADMINISTRATORS AND CONSULTANTS INC BUSINESS MANAGEMENT SERVICES BUSINESS MEN'S ASSUR. CO. OF AMERICA BUTLER BENEFIT SERVICE INC C & A CONTINENTAL INS C B A G T ADMINISTRATION C C SYSTEMS CORPORATION OF TEXAS 1395-00 2348-00 1969-00 2328-00 2952-00 2171-00 0080-00 3761-00 1047-00 1410-00 1204-00 MINNEAPOLIS LITTLE ROCK COLUMBUS FREMONT REYNOLDSBURG ALEXANDRIA KANSAS CITY DAVENPORT PASADENA PENSACOLA HOUSTON MN AR GA CA OH LA MO LA TX FL TX 55440 72203 31908 94538 43068 71303 64141 52808 77502 32507 77002 C D S GROUP HEALTH C R ANTHONY COMPANY (SELF INSURED) C.A.M.E. C.O. INDUSTRIES CADDO RETIRED INSURANCE PLAN CADDO-BOSSIER ASSOCIATION OF RETARDED CITIZENS CADILLAC INSURANCE CO CAJUN BAG & SUPPLY CO (SELF-INSURED) CAJUN CHEF PRODUCTS INC CAL-MAINE FOODS CALCASIEU MARINE NATIONAL BANK(SELF-INSURED) 3012-00 1450-00 1263-00 2077-00 2358-00 1731-00 2256-00 2238-00 0954-00 2193-00 P O BOX 8200 P O BOX 981706 P O BOX 981706 P O BOX 846 1975 OLD MINDEN RD 1407 DECATUR ST P O DRAWER 988 P O BOX 5224 P O BOX 9445 801 LAKEVIEW DR SUITE 301 P O BOX 2843 P O BOX 1028 SELF INSURED BENEFIT SERV 1030 HIGGINS RD P O BOX 1688 P O BOX 2480 P O BOX 922001 P O BOX 1080 P O BOX 29 P O BOX 1052 P O BOX 52453 P O BOX 1030 2580 WALNUT HILL LANE 39420 LIBERTY ST SUITE 260 BOX 100 600 BRICKELL AVE SUITE 701 P O BOX 40 P O BOX 8002 P O BOX 7966 39420 LIBERTY/STE 260 P O BOX 107 1006 CALAIS CIRCLE BUSINESS MEN'S ASSURANCE P O BOX 3310 213 WESTMORE STE 305 3420 BARRACAS AVE SUITE 2120 440 LOUISIANA STREET P O BOX 50190 P O BOX 25725 P O BOX 620 P O BOX 52009 351 JORDAN 31155 NORTHWESTERN HWY 115 WEST 1ST ST P O BOX 248 PO BOX 100 P O BOX 3402 SPARKS OKLAHOMA CITY JEANERETTE SHREVEPORT SHREVEPORT FARMINGTON HILLS CROWLEY ST.MARTINVILLE WALKER LAKE CHARLES NV OK LA LA LA MI LA LA LA LA 89435 73125 70544 71135 71101 48018 70526 70582 70785 70702 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 17 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP CALCASIEU MARINE NATIONAL BANK-SELF FUNDED HEALTH INS CALCASIEU PARISH SCHOOL BOARD CALCASIEU PARISH SHERIFF DEPARTMENT CALIFORNIA IRONWORKERS FIELD WELFARE PLAN CALIFORNIA LIFE INS. CO. CALIFORNIA PACIFIC INSURANCE SERVICES INC CALIFORNIA WESTERN MANAGEMENT BENEFIT TRUST FUND CALIFORNIA-WESTERN STATES LIFE INS. CO. CAM ADMINISTRATIVE SERVICES,INC CAMBRIDGE INTERGRATED SVCS(FORMERLY PRESIDIUM INC) CAMCO INTERNATIONAL INC CAMECO GROUP BENEFITS CAMELOT HEALTHCARE LLC CAMPBELL TAGGART INC/RAINBO BAKING CO 2206-00 1822-00 1939-00 0855-00 0081-00 1132-00 2031-00 0082-00 2344-00 3092-00 2388-00 2189-00 3140-00 1252-00 LAKE CHARLES LAKE CHARLES LAKE CHARLES SAN MARINO LOS ANGLES TUSTIN FREEMONT SACRAMENTO SOUTHFIELD PASSIPPANY GRAY THIBODAUX RAYNE DALLAS LA LA LA CA CA CA CA CA MI NJ LA LA LA TX 70602 70602 70602 91108 90010 92681 94537 95814 48086 07054 70359 70302 70578 75266 CANADA LIFE CANADA LIFE ASSURANCE CO., THE 3204-00 0083-00 BUFFALO ONTARIO NY ON 14240 00000 CANNON EXPRESS GROUP BENEFITS CANNON, COCHRAN, MANAGEMENT SERVICE CAPITAL SERVICES CORPORATION CAPITOL ADMINISTRATORS CAPITOL AMERICAN LIFE INS. CO. CAPITOL CARE CAPITOL LIFE INS. CO., THE CAPITOL MANUFACTURING EMPLOYEE BENEFIT CORP CAPITOL STEEL, INC CAPP CARE HEALTH CHOICE CAPROCK HEALTH PLANS CARBO CERAMICS INC 2988-00 0032-10 1424-00 3011-00 0084-00 2225-00 0085-00 0966-00 1770-00 2472-00 3955-00 2896-00 SPRINGDALE METAIRIE JACKSON ALPHARETTA CLEVELAND VIENNA DENVER CROWLEY BATON ROUGE FLOWER MOUND EGAN DALLAS AR LA MS GA OH VA CO LA LA TX MN TX 72765 70009 39206 30009 44114 22183 80201 70526 70896 75028 55121 75261 CARDINAL WIRELINE (SELF-INSURED) CARE AMERICA CARE CHOICES CARE IMPROVEMENT PLUS CARE IMPROVEMENT PLUS OF MARYLAND 2086-00 1214-00 3358-00 H652-80 H566-50 NEW IBERIA CONROE FARMINGTON LINTHICUM BALTIMORE LA TX MO MD MD 70562 77305 48333 21090 21201 CARE MARK CARE SCAN CARE-N-TRUST CAREFIRST CAREFIRST (BLUE CROSS) CAREINGTON INTERNATIONAL CAREMARK CAREMORE 2308-00 1576-00 2325-00 3340-00 3792-00 3009-00 3744-00 3913-00 LINCOLNSHIRE CLEARWATER JACKSON OWINGS MILL LEXINGTON DALLAS PHOENIX CERRITOS IL FL MS MD KY TX AZ CA 60069 34617 39236 21117 40512 75240 85072 90703 CAREMORE CARESTREAM SCRIP CARITEN HEALTH CARE CARNATION COMPANY,THE H054-40 2767-00 3225-00 0938-00 P O BOX 3402 P O BOX 3090 P O BOX V 475 HUNTINGTON DRIVE 3255 WILSHIRE BLVD. P O BOX 1827 P O BOX 820 POST OFFICE BOX 959 P O BOX 5131 P O BOX 365 P O BOX 818 P O BOX 968 201 E LOUISIANA AVE 6211 LEMMON AVE P O BOX 660217 P O BOX 1379 330 UNIVERSITY AVENUE TORONTO 1 P O BOX 364 P O BOX 6794 P O BOX 10681 P O BOX 346 1001 LAKESIDE AVE P O BOX 6000 POST OFFICE BOX 1200 1125 CAPITOL AVENUE P O BOX 66636 P O BOX 271080 P O BOX 21548 EMPLOYEE'S BENEFIT PLAN P O BOX 619110 P O DRAWER 9350 P O BOX 3043 P O BOX 9082 P O BOX 488 351 WEST CAMDEN ST STE 100 P O BOX 800 P O BOX 899 P O BOX 16707 10455 MILL RUN CIRCLE P O BOX 14116 13155 NOEL RD P O BOX 52196 12900 PARK PLAZA DR SUITE 150 P O BOX 366 448 E 6400 S SUITE 400 P O BOX 22987 5625 FM 1960 W SUITE 317 ARTESITA SALT LAKE CITY KNOXVILLE HOUSTON CA UT TN TX 90702 84107 37933 77069 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 18 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP CAROLINA BENEFIT ADMINISTRATORS 3131-00 SPARTANBURG SC 29304 CARPENTER HEALTH & WELFARE FUND LOCAL #953 1400-00 LAKE CHARLES LA 70601 CARPENTER'S LOCAL 1098 FRINGE BENEFITS FUNDS CARPENTERS HEALTH & SECURITY TRUST CARPENTERS HEALTH & WELFARE TRUST-SOUTHERN CALIFORNIA CARPENTERS LOCAL UNION INS. & PENSION PROGRAM CARPENTERS LOCAL UNION 1811 HLT & WELFARE PLAN CARPENTERS LOCAL 1897 - HEALTH AND WELFARE FUND CARPENTERS REGIONAL COUNCIL CARPENTERS UNION LOCAL 1846 1465-00 3723-00 2161-00 0531-00 0795-00 1444-00 1945-00 0504-00 BATON ROUGE SEATTLE LOS ANGELES BATON ROUGE MONROE STERLINGTON BATON ROUGE NEW ORLEANS LA WA CA LA LA LA LA LA 70814 98111 90076 70805 71211 71280 70814 70116 CARRON & BLACK BENEFITS INC CARTER'S INSURANCE CASEMARK CLAIMS DEPARTMENT CASINO AMERICA INC CATALYST RX 2228-00 2489-00 3513-00 2741-00 3416-00 NASHVILLE CENTREVILLE SAN ANTONIO NEW ORLEANS ROCKVILLE TN MS TX LA MD 37202 39631 78268 70152 20850 CATALYST RX 3390-00 ROCKVILLE MD 20850 CATALYST RX CATALYST RX CATAMARAN CATERPILLAR,INC CATHOLIC DAUGHTERS OF AMERICA CATHOLIC GOLDEN AGE INSURANCE CATHOLIC KNIGHTS OF AMERICA, THE CBA BLUE CBCA ADMINISTRATORS CBCA ADMINISTRATORS CBCA ADMINISTRATORS CBCA ADMINISTRATORS CBI EQUIFAX GROUP BENEFITS CBPI CLIAM FIDUCIARY ACCOUNT 3896-00 3220-00 3960-00 1374-00 1406-00 0862-00 0798-00 3850-00 3780-00 3701-00 3429-00 3305-00 0924-00 3579-00 ROCKVILLE BATON ROUGE DEERFIELD PEORIA CHANTILLY SCRANTON ST LOUIS S BURLINGTON PLANO MINNEAPOLIS BEATTYVILLE SAVANNAH ATLANTA TAMPA MD LA IL IL VA PA MO VT TX MN KY GA GA FL 20849 70804 60015 61629 22021 18503 63139 05407 75025 55440 41311 31416 30309 33623 CCEBT (CARLSON COMPANY EMPLOYEE BENEFIT TRUST) CCMSI CEIBA - GEIGY CELTIC INS CO CELTIC INSURANCE COMPANY CELTIC INSURANCE COMPANY 0950-00 3210-00 1197-00 3814-00 3848-00 3914-00 MINNEAPOLIS METAIRIE ST GABRIEL INDIANAPOLIS LITTLE ROCK CHICAGO MN LA LA IN AR IL 55440 70009 70776 46203 72221 60606 CELTIC LIFE INS. CO. 0086-00 CHICAGO IL 60604 CELTIC SHORT TERM HEALTH CEMENT MASON'S LOCAL #567 HEALTH & WELFARE PLAN CENAC TOWING CO INS CENTENNIAL LIFE INS. CO., THE CENTRA CENTRAL & SOUTHWEST SYSTEM MEDICAL PLAN 3845-00 2435-00 2000-00 0087-00 2352-00 0908-00 P O BOX 3257 333 SOUTH PINE STREET ADMINISTRATIVE SERVICES 1715 COMMON ST (WELFARE & PENSION) P O BOX 1029 P O BOX 76827 5219 CHOCTAW DR. P O BOX 4617 P O BOX 812 8875 GREENWELL SPRINGS RD PENSION SERVICE 1407 DECATUR ST. 289 PLUE PARK BLVD P O BOX 610 P O BOX 686005 P O BOX 56549 800 KING FARM BLVD 4TH FLOOR 800 KING FARM BLVD 4TH FLR P O BOX 1069 P O BOX 44036 P O BOX 545 100 N E ADAMS STREET 14325 WILLARD RD 400 LACKAWANNA AVENUE 3525 HAMPTON AVENUE P O BOX 2365 P O BOX 251369 P O BOX 1339 P O BOX 902 P O BOX 16579 1600 PEACHTREE NW FAIRMONT SPECIALTY GROUP P O BOX 26222 PO BOX 1755 P O BOX 6794 P O BOX 11 P O BOX 33839 P O BOX 26440 233 W WACKER DR STE 700 208 S LASALLE STREET STE. 1644 P O BOX 4136 10054 I-10 SERVICE RD E P O BOX 2617 POST OFFICE BOX 470 P O BOX 869043 C/O SWEPCO PO BOX 21106 CAROL STREAM NEW ORLEANS HOUMA OVERLAND PARK PLANO SHREVEPORT IL LA LA KS TX LA 60197 70127 70361 66201 75086 71156 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 19 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP CENTRAL BANK CENTRAL BENEFITS CENTRAL BENEFITS NATIONAL INSURANCE CO. 2244-00 2417-00 1593-00 SHREVEPORT PLANO MEMPHIS LA TX TN 71137 75086 38111 CENTRAL CENTRAL CENTRAL CENTRAL CENTRAL CENTRAL CENTRAL CENTRAL 2924-00 0875-00 0088-00 2834-00 0089-00 0090-00 0091-00 0090-01 P O BOX 70100 P O BOX 869043 C/O PITTMAN & ASSOCIATES P O BOX 116047 P O BOX 2638 PO BOX 5922 400 BENEFICIAL CENTER 17800 ROYALTON RD POST OFFICE BOX 2488 POST OFFICE DRAWER 151 POST OFFICE BOX 34350 SOUTHEAST & SOUTHWEST DIV P O BOX 323 P O BOX 5116 WORTHAM TOWER 6TH FLOOR 2727 ALLEN PARKWAY P O BOX 925309 207 NINTH STREET P O BOX 2256 P O BOX 4065 9201 WATSON RD/STE 350 HUMAN RESOURCES DEPT P O BOX 4065 P O BOX 165750 14724 VENTURA BLVD. 5 GATEWAY CENTER/STE 620 60 BLVD. OF THE ALLIES P O BOX 51118 P O BOX 23468 P O BOX 9201 P O BOX 2968 BENEFITS ADM MED CLAIMS KNIGHTSBRIDGE 2175 N GLENVILLE RD P O BOX 7927 P O BOX 469064 500 LENA DR P O BOX 359 149 TEATS ST P O BOX 52115 POST OFFICE BOX 4020 8301 MARYLAND AVENUE P O BOX 509508 P O BOX 18108 1122 GRAY HIGHWAY POST OFFICE BOX 297 P O BOX 1884 2627 LINWOOD AVE SOCIETY OF THE DIVINE WOR 201 RUELLA AVE 200 HENRY CLAY WACO MADISON PEAPACK STRONGVILLE FORTH WORTH ALEXANDRIA OMAHA DES PLAINES TX WI NJ OH TX LA NE IL 76702 53705 07997 44136 76101 71301 68134 60017 DESPLAINES HOUSTON IL TX 60017 77019 HOUSTON DES MOINES GRAPEVINE MONROE ST LOUIS MONROE TX IA TX LA MO LA 77292 50307 76099 71211 63126 71201 KANSAS CITY SHERMAN OAKS PITTSBURGH MO CA PA 64117 91403 15222 NEW ORLEANS LEXINGTON AUSTIN HUNTIN HAMILTON LA KY TX VA OH 70130 40523 78766 25728 45020 RICHARDSON MADISON DENVER AURORA TX WI CO OH 75081 53707 80246 44202 WINNS BORO PHOENIX LAFAYETTE CLAYTON GRAND PRAIRIE OKLAHOMA CITY MACON BALTIMORE AKRON SHREVEPORT BAY ST LOUIS LA AZ LA MO TX OK GA MD OH LA MS 71295 85072 70502 63105 75053 73154 31201 21202 44309 71103 38520 NEW ORLEANS LA 70118 FREIGHT LINES EMPLOYEES SECURITY PLAN LIFE ASSURANCE CO NATIONAL LIFE INS. CO. OF OMAHA, THE RESERVE LIFE HEALTH INSURANCE SECURITY LIFE INS. CO. STATE LIFE INS. CO. STATES HEALTH & LIFE CO. OF OMAHA STATES INS CO - CENTRAL STATES SE AND SW AREAS CENTRAL UNITED INSURANCE CO. 1012-00 2595-00 CENTRAL UNITED LIFE CENTURION LIFE INS. CO. CENTURY HEALTHCARE CENTURY MEDICAL BANKERS LIFE & CASUALTY CENTURY PLANNERS CENTURY TELEPHONE ENTERPRISE 3854-00 0092-00 3489-00 0794-00 3221-00 1079-00 CERNER HEALTH PLANS CERTIFIED LIFE INS. CO. CF&I RETIREES, VEBA 3980-00 0093-00 3580-00 CFB DREDGING CO-SELF-INSURED CHA HEALTH CHAIN ELECTRIC - SELF INSURED CHAMPION HEALTH INSURANCE FUND CHAMPION INTERNATIONAL CORPORATION 3405-00 3267-00 3516-00 3035-00 1463-00 CHAMPIONS LIFE CHAMPUS/TRICARE CHAMPVA CHANDLER & ASSOCIATES 2278-00 0518-00 3339-00 2457-00 CHARLYN ENTERPRISES CHARMING SHOPPES RX DRUG PLAN CHART HOUSE INC. CHARTER NATIONAL LIFE INS. CO. CHEC INSURANCE CHER A. BUMPS AND ASSOCIATES CHEROKEE NATIONAL LIFE INS. CO. CHESAPEAKE LIFE INS. CO., THE CHESTERFIELD RESOURCES INC CHEVYLAND INSURANCE CHICAGO PROVINCE MEDICAL PLAN 3313-00 1655-00 0525-00 0094-00 3028-00 2962-00 0095-00 0096-00 1350-00 2585-00 3545-00 CHILDREN'S HOSPITAL HEALTH PLAN 1643-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 20 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP CHITIMACHA EMPLOYEES HEALTH PLAN CHOICE BENEFIT ASSOCIATION CHOICE BRANDS INC CHOICE CARE MANAGED SYSTEM INC CHOICE NATIONAL CHOICE NET INTERCARE CHOICE PLAN MEMBER 2774-00 2979-00 2538-00 2378-00 3529-00 3187-00 2718-00 CHARENTON TIGARD SHREVEPORT MELVILLE LEXINGTON ENGLEWOOD METAIRIE LA OR LA NY KY CO LA 70523 97281 71137 11747 40512 80155 70005 CHOICE PLUS ERISA ADMINISTRATIVE SERVICES 2783-00 PHOENIX AZ 85016 CHOUEST GROUP HEALTH PLAN CHRISTIAN BROTHERHOOD CHRISTIAN BROTHERS CHRISTIAN CARE MEDI-SHARE CHRISTIAN FIDELITY LIFE INS COMPANY CHRISTIAN HEALTH MINISTRIES CHRISTIAN HOSPITALIZATION AID CHRISTUS HEALTH/TEXAS TRUE CHOICE CHRISTUS PHCS CHRISTUS ST PATRICK HOSPITAL (SELF-INSURED) CHRYSLER LIFE INS. CO. CHUBB LIFE AMERICA CHURCH MUTUAL INSURANCE CO CHURCH OF GOD IN CHRIST INC 3180-00 1130-00 0885-00 3482-00 0949-00 2708-00 0895-00 3255-00 3598-00 3060-00 0097-00 1578-00 3209-00 1895-00 EXTON BEDFORD ROMEOVILLE STERLING WAXAHACHIE NEW ORLEANS MONTEZUMA PLANO MINNEAPOLIS LAKE CHARLES TROY CHATTANOOGA MERRILL NORFOLK PA TX IL IL TX LA KS TX MN LA MI TN WI VA 19341 76021 60446 61081 75165 70115 67867 75025 55440 70602 48098 37401 54452 23502 CHURCH POINT INDUSTRIES CIBA-GEIGY CORP CIERRA HEALTH & LIFE CIGNA CIGNA CIGNA CIGNA CIGNA CIGNA CIGNA CIGNA CIGNA 2218-00 2187-00 3216-00 3347-00 3346-00 3344-00 3343-00 3342-00 3510-00 3462-00 3459-00 3349-00 CHURCH POINT ST. GABRIEL LATHAM PLAINVILLE COLUMBUS ATLANTA COLUMBUS CHARLOTTE VISALIA SCRANTON SCRANTON SOUTHFIELD LA LA NY CT OH GA OH NC CA PA PA MI 70525 70776 12110 06062 43218 30359 43216 28233 93278 18505 18505 48034 CIGNA CIGNA CIGNA CIGNA CIGNA CIGNA CIGNA CIGNA CIGNA CIGNA CIGNA CIGNA CIGNA 3348-00 1740-00 1261-00 H276-20 3886-00 3642-00 0871-00 1083-00 0708-00 3721-00 3415-00 3389-00 4000-00 P O BOX 39 P O BOX 23018 P O BOX 70100 395 N SERVICE RD P O BOX 14586 P O BOX 3559 111 VETERANS MEM BLVD STE 425 4527 NORTH 16TH STREET SUITE 102 P O BOX 691 P O BOX 681 1205 WINDHAM PARKWAY P O BOX 674 316 DALLAS HWY 2700 NAPOLEON AVENUE P O BOX 336 P O BOX 250089 P O BOX 1339 P O BOX 1393 900 TOWER DRIVE P O BOX 551 P O BOX 342 HOSPITAL FUND 5739 SELLGER DR P O DRAWER A P O BOX 11 P O BOX 730 P O BOX 8012 P O BOX 182331 P O BOX 29000 P O BOX 16672 P O BOX 33638 P O BOX 5026 P O BOX 5300 P O BOX 3598 26913 NORTHWESTERN HWY SUITE 300 P O BOX 15408 P O BOX 18223 32 VALLEY ST P O BOX 182223 1000 GREAT WEST DR P O BOX 55270 P O BOX 2546 P O BOX 2100 PO BOX 182223 P O BOX 5909 P O BOX 46270 P O BOX 46270 900 COTTAGE GROVE RD WILMINGTON CHATTANOOGA BRISTOL CHATTANOOGA KENNETT PHOENIX SHERMAN BOURBONNAIS CHATTANOOGA SCRANTON EDENPRAIRIE EDEN PRAIRIE BLOOMFIELD DE TN CT TN MO AZ TX IL TN PA MN MN CT 19850 37422 06010 37422 63857 85078 75091 60914 37422 18505 55344 55344 06002 (BOILERMAKERS) BEHAVIORAL BEHAVIORAL HEALTH CORPORATE HEADQUARTERS LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 21 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP CIGNA DENTAL CIGNA GOVERNMENT SERVICES CIGNA INTERNATIONAL EXPARTIATE BEN CIGNA MEDICARE ACCESS PLUS CIGNA VOLUNTARY CINERGY HEALTH CIRCLE K CORPORATION 3803-00 3576-00 3677-00 H035-40 3904-00 3589-00 2329-00 PLANTATION NASHVILLE WILMINGTON SAN ANTONIO PHOENIX LAKE HIAWATHA SHREVEPORT FL TN DE TX AZ NJ LA 33318 37202 19850 78269 85051 07034 71104 CITADEL LIFE INS. CO., THE CITGO PETROLEUM GROUP HEALTH CARE CITIZENS FIDELITY INSURANCE COMPANY CITIZENS INS. CO. OF AMERICA CITIZENS SECURITY LIFE INS. CO. CITY HEALTH PLAN 0098-00 1116-00 0956-00 0099-00 2231-00 3059-00 CHARLOTTE TULSA LITTLE ROCK AUSTIN LOUISVILLE SAN FRANCISCO NC OK AR TX KY CA 28231 74101 72202 78714 40253 94103 CITY OF ALEXANDRIA BENEFIT CONTROL SERVICES CITY OF AUSTIN 1702-00 2354-00 DENHAM SPRINGS AUSTIN LA TX 70727 78750 CITY CITY CITY CITY CITY CITY CITY CITY CITY 2072-00 1441-00 1175-00 0720-00 1883-00 0747-00 2327-00 1445-00 2848-00 P O BOX 189060 P O BOX 20010 P O BOX 15050 P O BOX 696018 P O BOX 55270 144 N BEVERWYCK US DENTAL INSURANCE 3645 SOUTHERN AVE POST OFFICE BOX 31488 P O BOX 3648 901 MARSHALL POST OFFICE BOX 149151 P O BOX 436149 1145 MARKET STREET 2ND FLOOR P O BOX 758 12325 HY MEADOW DR BLDG 4 P O BOX 80666 P O BOX 5756 P O BOX 15230 201 N ECTOR DR 511 N CUSHING P O BOX 4017C P O BOX 900 P O BOX 698 1360 PEACHTREE ST N.E. SUITE 325 PO BOX 12830 P O BOX 37 1300 PERDIDO ST P O BOX 5756 P O BOX 379 P O BOX 3968 SUITE 402 1575 SAN IGNACIO P O BOX 10888 2240 EAST PRIEN LAKE ROAD HEALTH BENEFITS PLAN P O BOX 1837 P O BOX 1459 P O BOX 5000 P O BOX 51005 7124 WINDSOR LAKE PARKWAY P O BOX 11549 P O BOX 8002 P O BOX 76149 OFF.OF WORKERS COMP.PROG. ROOM C-3316 P O BOX 101387 P O BOX 2175 BATON ROUGE SHREVEPORT DALLAS EULESS KAPLAN LAFAYETTE LAKE CHARLES MARSHALL ATLANTA LA LA TX TX LA LA LA TX GA 70898 71135 75201 76039 70548 70502 70602 75671 30309 JACKSON NATCHITOCHES NEW ORLEANS SHREVEPORT ST MARTINVILLE BOCA RATON CORAL GABLES MS LA LA LA LA FL FL 39236 71457 70112 71135 70582 33427 33146 GREENBAY LAKE CHARLES LAS VEGAS WI LA NV 54307 70601 89125 BILOXI PINEVILLE SHREVEPORT ROCKFORD TUCSON LITTLE ROCK COLORADO SPRINGS WASHINGTON MS LA LA IL AZ AR CO DC 39533 71361 71135 61111 85734 72203 80970 20210 FORT WORTH MONROE TX LA 76185 71207 OF OF OF OF OF OF OF OF OF BATON ROUGE BOSSIER CIYT MEDICAL BENEFIT PLAN DALLAS HEALTH BENEFIT PLAN EULESS EMPLOYEE BENEFIT PLAN KAPLAN EMPLOYEE BENEFIT TRUST LAFAYETTE LAKE CHARLES MARSHALL, TEXAS (SELF-EMPLOYED) MEMPHIS-TN PRIMARY CARE NETWORK CITY OF MONROE INSURANCE SYSTEMS CITY OF NATCHITOCHES CITY OF NEW ORLEANS GROUP PLAN CITY OF SHREVEPORT HEALTH CARE PLAN CITY OF ST MARTINVILLE CLAIMS ADMINISTRATION SERVICES INC CLAIMS DEVELOPMENT CORP-ROTOCAST PLASTIC PRODUCTS INC 0873-00 1357-00 0771-00 1177-00 2037-00 1986-00 1662-00 CLAIMS MANAGEMENT SERVICES INC CLARK COLLEGE CLARK COUNTY NEVADA & AFFILIATES SELF FUNDED 2460-00 2047-00 2937-00 CLASSIC HEALTH CLECO (CENTRAL LA. ELECTRIC CO.) CLEMENT INDUSTRIES INC CLINICARE CMC STEEL GROUP-WEST CNA INSURANCE CO/HEALTHSCOPE BENEFITS CNIC HEALTH SOLUTIONS COAL MINE WORKERS COMP-DEPT OF LABOR 1621-00 1512-00 2324-00 1847-00 3172-00 0817-00 3296-00 1704-00 COALITION AMERICA COASTAL DRILLING LAND 2946-00 3423-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 22 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP COASTAL STATES LIFE INS. CO. COATES FIELD SERVICE INC COBRA ADMINISTRATIVE SERVICES COLE MANAGED VISION COLLEGE LIFE INS. CO. OF AMERICA, THE COLONIAL LIFE & ACCIDENT COLONIAL LIFE INS. CO. OF AMERICA, THE COLONIAL PENN LIFE INS. CO. 0100-00 3290-00 2664-00 3130-00 0101-00 0102-00 0103-00 0104-00 ATLANTA OKLAHOMA CITY STONE MOUNTAIN TWINSBURG INDIANAPOLIS COLUMBIA PARSIPPANY PHILADELPHIA GA OK GA OH IN SC NJ PA 30343 73172 30087 44087 46268 29202 07054 19181 COLONIAL SUGARS INC MEDICAL PLAN 1683-00 GRAMERCY LA 70052 COLORADO COLUMBIA COLUMBIA COLUMBIA COLUMBIA H062-10 2060-00 1971-00 2669-00 0105-00 POST OFFICE BOX 56189 P O BOX 720460 P O BOX 870789 11925 ENTERPRISE PKWY POST OFFICE BOX 68181 1200 COLONIAL LIFE BLVD POST OFFICE BOX 216 HEALTH CLAIMS DEPT 1250 COLONIAL PENN PLAZA 129 S FIFTH ST P O BOX 3360 P O BOX 17470 P O BOX 683 RD 5 P O BOX 2180 88 E. BROAD STREET STE. 1800 COLUMBIA PLAZA, BOX 30 P O BOX 771989 VESTA PARKWAY EAST 303 EAST BROAD STREET P O BOX 1009 5050 N BROADWAY P O BOX 638 POST OFFICE BOX 2503 P O DRAWER 67 4800 DERAMUS SOUTHEAST ADMINISTRATORS P O BOX 900 200 SOUTH WACKER DRIVE SELF-FUNDED PLAN 333 TEXAS STREET 70 GENESEE ST ONE BEACON STREET POST OFFICE BOX 8080 COLLEGE STATION P O BOX 9016 COMMONWEALTH BUILDING FORTH AND BROADWAY POST OFFICE BOX 1057 1749 BERTAND DR P O BOX 317 P O BOX 7070 PLAN/GROUP PROGRAMS INC P O BOX 1180 155 FRANKLIN RD P O BOX 660451 AFC SERVICE CEN CK3-485 1351 WILLIAM H TAFT RD 218 W 6TH ST P O BOX 3028 DENVER HOUSTON BLOOMSBURG LOUISVILLE COLUMBUS CO TX PA KY OH 80217 77001 17815 40201 43215 GREENSBURG HOUSTON BINGHAMTON COLUMBUS LONGHORNE CHICAGO BELLINGHAM TYLER AUBURNDALE KANSAS CITY ELYRIA PA TX NY OH PA IL WA TX FL MO OH 15601 77215 13902 43216 19047 60640 98227 75710 33823 64120 44036 CHICAGO SHREVEPORT IL LA 60606 71101 UTIC BOSTON ST. LOUIS NY MA MO 13502 02108 63156 ANDOVER LOUISVILLE MA KY 01810 40202 CLEVELAND LAFAYETTE CULLEN METAIRIE BREAUX BRIDGE MS LA LA LA LA 38732 70506 71021 70010 70517 BRENTWOOD DALLAS CINCINNATI TN TX OH 37027 75266 45206 TULSA TULSA OK OK 74119 74102 ACCESS GAS SYSTEMS LIFE INSURANCE CO MEDICAL PLAN NATIONAL LIFE INS. CO. COLUMBIA PHARMACY SOLUTIONS COLUMBIA UNIVERSAL LIFE INSURANCE COLUMBIAN MUTUAL LIFE INS. CO. COLUMBUS MUTUAL LIFE INS. CO., THE COMBINED AMERICAN LIFE COMBINED INS. CO. OF AMERICA COMBINED INSURANCE COMBINED UNDERWRITERS LIFE INS. CO. COMCAR INDUSTRIES (SELF-INSURED) COMET INDUSTRIES INC COMMERCE BENEFITS PLANS INC 2792-00 1128-00 0106-00 0107-00 0773-00 0108-00 3754-00 0109-00 2568-00 2223-00 3034-00 COMMERCIAL LIFE INS. CO. COMMERCIAL NATIONAL BANK 0110-00 1503-00 COMMERCIAL TRAVELERS COMMERCIAL UNION LIFE INS. CO. OF AMERICA COMMONWEALTH LIFE AND ACCIDENT INS. CO. 3906-00 0111-00 0112-00 COMMONWEALTH LIFE INS CO COMMONWEALTH LIFE INS. CO. 3709-00 0113-00 COMMONWEALTH NATIONAL LIFE INS. CO. COMMUNICATION CORP COMMUNITY AMBULANCE SERVICE COMMUNITY CARE NETWORK COMMUNITY HEALTH ALLIANCE SUMMIT INS 0114-00 3106-00 1614-00 2284-00 1397-00 COMMUNITY HEALTH SYSTEM INC COMMUNITY HEALTH/UNITED HCA COMMUNITY MUTUAL INSURANCE CO 2907-00 1193-00 1237-00 COMMUNITYCARE OF OKLAHOMA COMP MED-CITY OF OKLAHOMA CITY 3844-00 2141-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 23 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP COMP SYCH CORPORATION COMPANION LIFE INS. CO. COMPASS ROSE BENEFITS COMPLETE BENEFIT SOLUTIONS COMPLETE HEALTH COMPREHENSIVE BENEFIT ADMINISTRATOR INC 3444-00 2532-00 3977-00 3171-00 2006-00 1326-00 CHICAGO COLUMBIA ANNAPOLIS DENHAM SPRINGS BIRMINGHAM MIAMI IL SC MD LA AL FL 60680 29260 21401 70726 35205 33183 COMPREHENSIVE CARE SERVICES COMPREHENSIVE CARE SERVICES INC CON AGRA GROUP INSURANCE CON CHO (SELF-INSURED) CON-AIR CORP CONAGRA MEDICAL INSURANCE PLAN CONCERT HEALTH PLAN 3275-00 3299-00 1049-00 1772-00 1183-00 0733-00 3219-00 ST PAUL ST PAUL NATCHITOCHES GARLAND EDISON JEANERETTE OAKBROOK MN MN LA TX NJ LA IL 55164 55164 71458 75042 08816 70544 60523 CONCESSION AIR CONCORDIA HEALTH PLAN OF THE LUTHERAN CHURCH CONEXIS CONFEDERATION ADMINISTRATION SERVICES CONFEDERATION LIFE INS. CO. 2175-00 0745-00 3544-00 1479-00 0115-00 INDIANAPOLIS ST LOUIS DALLAS CHICAGO ONTARIO IN MO TX IL ON 46706 63122 75222 60606 00000 CONFEDERATION LIFE INSURANCE 0115-01 SANTURCE PR 00910 CONGER LIFE INS. CO. 0116-00 MIAMI FL 33137 CONGRESS LIFE INC 2779-00 RICHARDSON TX 75083 CONNECTICUT CARE CONNECTICUT GENE CONNECTICUT GENE CONNECTICUT GENERAL CONNECTICUT GENERAL LIFE INS CO CONNECTICUT GENERAL LIFE INS. CO. CONNECTICUT GENERAL LIFE INSURANCE COMPANY CONNECTICUT MUTUAL LIFE INS. CO. CONNECTICUT NATIONAL LIFE CONNECTION DENTAL CONSECO HEALTH INS CO CONSOCIATE CONSOCIATE CONSOLIDATE HEALTH PLANS,INC CONSOLIDATED ADMINISTRATORS CONSOLIDATED AMERICAN LIFE INS. CO. CONSOLIDATED BANKERS LIFE INS. CO. OF LA CONSOLIDATED BENEFITS HEALTH CARE FUND 6 CONSOLIDATED BENEFITS SERVS C/O CARPENTERS LOCAL 3582-00 1164-00 1155-00 1044-00 3870-00 0506-00 0830-00 0117-00 1285-00 3933-00 2983-00 3676-00 3618-00 2713-00 2025-00 0118-00 0119-00 2177-00 1988-00 FARMINGTON PLAINVILLE PLAINVILLE SHERMAN PHOENIX SHERMAN PLAINVILLE HARTFORD SHREVEPORT INDEPENDENCE CARMEL DECATUR DECATUR METAIRIE RALEIGH JACKSON SHREVEPORT PHOENIX ATLANTA CT CT CT TX AZ TX CT CT LA MO IN IL IL LA NC MS LA AZ GA 06034 06062 06062 75091 85078 75090 06062 06115 71161 64051 46032 62525 62525 70004 27627 39205 71130 85078 30319 CONSOLIDATED EMPLOYEE BENEFITS 2665-00 STONE MOUNTAIN GA 30087 CONSOLIDATED FREIGHTWAYS INC HEALTH PLAN CONSOLIDATED GRAIN 2040-00 2268-00 P O BOX 8379 P O BOX 6000 P O BOX 6430 102 NORTH RANGE 2160 HIGHLAND AVE/STE 100 7990 S W 117TH AVE SUITE 134 P O BOX 64668 P O BOX 64668 P O BOX 1008 196 INTERNATIONAL 11 EXECUTIVE AVENUE P O BOX 228 2605 W 22ND ST STE 25 P O BOX 1860 1333 S KIRKWOOD RD P O BX 226101 250 SOUTH WACKER DR 321 BLOOR STREET, EAST TORONTO 5 P O BOX 11007 FERNANDEZ JUNCOS STATION POST OFFICE BOX 1068 BUENA VISTA STATION BLIC ADMINISTORS P O BOX 836150 P O BOX 546 80 SPRING LANE 80 SPRING LANE P O BOX 2546 P O BOX 55270 POST OFFICE BOX 2546 POST OFFICE BOX 8014 140 GARDEN STREET P O BOX 1 P O BOX 2336 11825 N PENNSYLVANIA ST 151 E DECATURE ST 151 E DECATURE ST P O BOX 1878 P O BOX 37429 POST OFFICE BOX 59 POST OFFICE BOX 3999 P O BOX 55237 UNION #225 1400 LAKE HEARN DR #300 2300 WEST PARK PLACE BLVD SUITE 114 P O BOX 3988 P O BOX 677 PORTLAND GREENFIELD OR MA 97208 01302 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 24 TPL CARRIER FILE LISTING CARRIER NAME CONSOLIDATED CONSOLIDATED CONSOLIDATED CONSOLIDATED CONSOLIDATED CONSOLIDATED CONSTITUTION CONSTRUCTION GROUP HEALTH PLAN MEDICAL,DISABILITY & LIFE TRUST NATIONAL LIFE INSURANCE COMPANY TRANSPORTATION INSURANCE TRUST FUND WATERWORKS LIFE INS. CO. & GENERAL CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP 2700-00 2712-00 0911-00 2426-00 2720-00 3734-00 0120-00 0530-00 P O BOX 432910 P O BOX 1878 3900 THANKSGIVING TOWER P O BOX 349 810 EMMERTON RD P O BOX 12549 325 WEST TOUHY AVENUE LABORERS LOCAL UNION 1177 1233 GOVERNMENT ST. 116 COMMERCE DRIVE 6310 W APPLETON AVE P O BOX 720 P O BOX 201425 3420 BARANCAS AVE 2100 M STREET, N.W. 500 MAYO SHELL P O BOX 72 300 CONTINENTAL DRIVE 310 SOUTH MICHIGAN AVENUE 9000 DENTON DRIVE P.O. BOX 809008 CNA PLAZA P O BOX 30010 P O BOX 247007 POST OFFICE BOX 1599 101 CONTINENTAL PLACE CONTINENTAL LIFE BUILDING P O BOX 5904 P O BOX 1523 POST OFFICE BOX 242 POST OFFICE BOX 3397 POST OFFICE BOX 65770 P O BOX 470 P O BOX 1608 6300 BRIDGEPOINT PARKWAY BUILDING 3, SUITE 500 9003 WATERFORD CENTRE BLVD., SUITE 100 KERR MAGEE CTR PO BOX 833823 DEPT 199 P O BOX 217 P O BOX 1180 RT 12 BOX 252 P O BOX 6249 P O BOX 6249 P O BOX 7305 P O BOX 21517 P O BOX 26222 P O BOX 20594 P O BOX 15953 P O BOX 995 S.MIAMI METAIRIE DALLAS TROY ABINGTON LAKE CHARLES PARK RIDGE BATON ROUGE FL LA TX AL MD LA IL LA 33243 70004 75201 36081 21009 70612 60068 70802 JEFFERSON CITY MILWAUKEE DELAWARE ARLINGTON PENSACOLA WASHINGTON GALENA PARK MO WI OH TX FL DC TX 65101 53210 43015 76006 32507 20037 77547 NEWARK CHICAGO DALLAS DALLAS CHICAGO AUSTIN OMAHA BOISE BRENTWOOD FORT WORTH METAIRIE LANCASTER JEFFERSON CITY BATON ROUGE WEST DES MOINES SHAWNEO MISSION ROCKVILLE AUSTIN DE IL TX TX IL TX NE ID TN TX LA PA MO LA IA KS MD TX 19713 60604 75235 75380 60685 78755 68124 83701 37027 76102 70009 17603 65101 70821 50265 66201 20849 78730 AUSTIN TX 78758 OKLAHOMA CITY RICHARDSON MEMPHIS JENA TEXARKANA LINCOLN LINCOLN KANSAS CITY EAGAN TAMPA TAMPA LUBBOCK BIRMINGHAM OK TX TN LA AR NE NE MO MN FL FL TX AL 73125 75083 38101 71342 75502 68506 68506 64116 55121 33623 33622 79490 35298 CONSTRUCTION INDUSTRY LABORERS WELFARE FUND CONSTRUCTION WORKERS HEALTH FUND CONSULTANTS & ADMINISTRATORS (SELF-INSURED) CONSUMER ALLIANCE USA CONSUMER BENEFIT ASSOCIATION OF THE U.S. CONSUMERS UNITED INS. CO. CONTAINER CARE HOUSTON 0793-00 1871-00 1884-00 3647-00 1522-00 0121-00 2870-00 CONTINENTAL AMERICAN LIFE INS. CO. CONTINENTAL ASSURANCE CO. CONTINENTAL BAKING COMPANY CONTINENTAL BANKERS LIFE INS. CO. OF THE SOUTH CONTINENTAL CASUALTY CONTINENTAL GENERAL INSURANCE COM CONTINENTAL GENERAL INSURANCE COMPANY CONTINENTAL LIFE & ACCIDENT CO. CONTINENTAL LIFE INS CO CONTINENTAL LIFE INS. CO. CONTINENTAL LOSS ADJUSTMENT SERVICES INC CONTINENTAL MEDICAL SYSTEM INC CONTINENTAL SECURITY LIFE INS. CO. CONTINENTAL SERVICE LIFE AND HEALTH INS. CO. CONTINENTAL WESTERN LIFE INS. CO. CONTINUAL LIFE INSURANCE CO CONTINUED HEALTH CARE BENEFIT PROGRAM CONTRACTORS EMPLOYEE BENEFITS ADMIN 0122-00 0123-00 1368-00 0124-00 0756-00 3793-00 0125-00 0126-00 3705-00 0127-00 1789-00 1699-00 0128-00 0129-00 0130-00 1830-00 2688-00 3178-00 CONTRACTORS EMPLOYEE BENEFITS ADMINISTRATION INC 2994-00 CONTROL DATA CONTROL DATA HEALTH CARE SERVICES CONWOOD COMPANIES COOOPER-BELDEN CORPORATION SELF-INSURED COOPER TIRE COMPANY COOPERATIVE BENEFIT ADMINISTRATOR COOPERATIVE BENEFIT ADMINISTRATORS COOPERATIVE HEALTH ASSOCIATES COORDINATED BENEFIT PLANS COORDINATED BENEFITS COORDINATED BENEFITS CORE HEALTH CORE PPF 0786-00 1041-00 2908-00 1989-00 0804-00 2760-00 3813-00 1137-00 3965-00 3898-00 3851-00 3872-00 3903-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 25 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP CORE SOURCE CORESOURCE CORESTAR 2462-00 3465-00 3021-00 MATTESON CLINTON BROOKLYN CENTER IL IA MN 60443 52733 55430 CORPORATE BENEFIT SOLUTIONS INC CORPORATE BENEFITS SERVICE INC 3078-00 2387-00 LITTLE ROCK CHARLOTTE AR NC 72221 28202 CORPORATE CARE CORPORATE CLAIMS SERVICE INC 0872-00 2384-00 WORCHESTER CHARLOTTE MA NC 01613 28202 CORPORATE DIVERSIFIED SERVICE INC. 2420-00 OMAHA NE 68124 CORPORATE GROUP BENEFITS CORPORATE HEALTH ADMINISTRATORS 2239-00 2820-00 LIVONIA PITTSBURG MI PA 48151 15203 CORPORATE SERVICE INC CORROON & BLACK BENEFITS INC CORVEL 1985-00 1259-00 3194-00 BENTONVILLE NASHVILLE METAIRIE AR TN LA 72712 37202 70001 COST CARE COST MANAGEMENT TECHNOLOGIES INC 2517-00 2576-00 HUNTINGTON BEACH KANSAS CITY CA MO 92647 64111 COSTCO MEDICAL PLAN COTTER MEMBER INSURANCE (W/JOHN HANCOCK) COTTON BROTHERS BAKERY COUNTRY COMPANIES INSURANCE & INVESTMENT SERVICES COUNTRYMARK COOPERATIVE INC COUSHATTA INSURANCE PLAN COVENANT ADMINISTRATION COVENANT ADMINISTRATORS COVENANT ADMINISTRATORS, INC. 2772-00 1148-00 0893-00 1086-00 2753-00 2973-00 2808-00 3532-00 3608-00 LITTLE ROCK CARY ALEXANDRIA BLOOMINGTON DUBLIN ELTON ATLANTA ATLANTA LAWRENCEVILLE AR IL LA IL OH LA GA GA GA 72203 60013 71301 61702 43017 70532 30374 30348 30043 COVENTRY HEALTH CARE COVENTRY HEALTH CARE KS COVENTRY HEALTH CARE NATIONAL NETWK COVENTRY HEALTHCARE OF LA COX HEALTH SYSTEMS HMO INC CR-PL BENEFIT PLAN CRACKER BARREL STORES INC (SELF-INSURED) CRAIN BROTHERS INC CRAWFORD & COMPANY CREATIVE PLANNING CREDIT LIFE INS. CO., THE CRESCENT DENTAL PLANS CREST INDUSTRIES (SELF-EMPLOYED) CROSSAMERICA HEALTH PLANS CROWN CORK & SEAL COMPANY CROWN LIFE INS. CO. CRUM AND FORSTER CST GROUP INC CSX BENEFITS 3001-00 3412-00 3535-00 3517-00 3133-00 1229-00 1487-00 1872-00 1036-00 1537-00 0131-00 3162-00 1507-00 3504-00 2663-00 0132-00 1926-00 1739-00 2008-00 P O BOX 168 P O BOX 2920 6200 SHINGLE CREEK PKWY SUITE 665 P O BOX 8215 139 S TRYON ST 6TH FLOOR PO BOX 1075 139 S TRYON ST SUITE 607 2120 SOUTH 727 ST SUITE 400 P O BOX 2908 MARQUIS PLAZA/STE 300 5313 CAMPBELLS RN RD P O BOX 1288 P O BOX 1140 1 GALLERIA BLVD STE 1775 17011 BEACH BOULEVARD 4435 MAIN SUITE 810 P O BOX 8049 203 JARDUS RD 3400 MCARTHUR DRIVE P O BOX 2000 P O BOX 9059 P O BOX 1029 P O BOX 740042 P O BOX 105738 1745 N BROWN RD SUITE 400 P O BOX 7707 P O BOX 7087 P O BOX 8400 3838 N CAUSEWAY BLVD P O BOX 5750 8290 SOUTH CENTRAL P O BOX 51005 P O BOX 1186 P O BOX 1086 4430 TULLER RD 100 S. LIMESTONE STREET P O BOX 30730 P O BOX 1432 P O BOX 5778 9300 ASHTON ROAD 120 BLOOR STREET 18383 PRESTON RD, STE 500 P O BOX 3011 DEPT J-905 P O BOX 44055 LONDON LONDON LONDON METAIRIE SPRINGFIELD DALLAS SHREVEPORT GRAND CHENIER HOUMA DUBIN SPRINGFIELD PHOENIX ALEXANDRIA PARSIPPANY PHILADELPHIA TORONTO DALLAS ARLINGTON JACKSONVILLE KY KY KY LA MO TX LA LA LA OH OH AZ LA NJ PA ON TX IL FL 40742 40742 40742 70002 65801 75239 71135 70643 70301 43017 45501 85046 71301 07054 19136 00000 75252 68006 32231 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 26 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP CTI ADMINISTRATORS CUDIS INS. SOCIETY, INC. CULINARY WORK HEALTH FUND CUMBERLAND LIFE INS. CO. CUNA MUTUAL INS. SOCIETY CVS CAREMARK 2951-00 0133-00 3122-00 0134-00 0135-00 3846-00 DES MOINES MADISON LOS VEGAS DALLAS MADISON IA WI NV TX WI AZ 50309 53701 89104 75266 53701 85072 CWI BENEFITS/MANAGEMED CYANAMID PERSONAL PROTECTION PROGRAM D & B PLAN SERVICES INC D & J CONSTRUCTION CO., INC (SELF-INSURED) D M B A 3675-00 0719-00 2317-00 2068-00 2332-00 GREENVILLE CLIFTON TAMPA SHREVEPORT SALT LAKE CITY SC NJ FL LA UT 29606 07015 33630 71135 84145 D.W.G. INSURANCE AND RISK MANAGEMENT DAKOTACARE DALLAS FT.WORTH ROOFERS & WATERPRO0FERS 1318-00 3235-00 2833-00 MIAMI BEACH SIOUX FALLS PLANO FL SD TX 33141 57105 75086 DALLAS GENERAL LIFE INS CO DALLAS NATIONAL DALLAS NATIONAL LIFE DANIEL AND HENRY GROUP ADMINISTRATIVE TRUST DAVEY TREE INS CO DAVIS ELECTRICAL CONSTRUCTION (SELF-INSURED) DAVIS GARVIN AGENCY DAVISON TRANSPORT DAYBROOK FISHERIES INC (SELF-INSURED) DBL SERVICES,INC DEAN HEALTH PLAN DEARBORN NATIONAL DEATON INC.(SELF-EMPLOYED) DEEP SOUTH EQUIPMENT CO. DEFINITY DEFINITY DEFINITY HEALTH 1920-00 2680-00 1709-00 1636-00 1588-00 1501-00 2247-00 1105-00 1848-00 1220-00 3327-00 3815-00 1304-00 1919-00 3382-00 3703-00 3146-00 DALLAS DALLAS DALLAS ST LOUIS KENT GREENVILLE COLUMBUS RUSTON EMPIRE NEW ORLEANS MADISON BELLVILLE BIRMINGHAM NEW ORLEANS AMHERST ATLANTA ST LOUIS PARK TX TX TX MO OH NC SC LA LA LA WI IL AL LA NY GA MN 75221 75380 75380 63103 44240 29602 29221 71270 70050 70176 53705 62223 35201 70129 14226 30374 55416 DELAM AMERICAN HEALTH TRUST,THE DELAWARE AMERICAN LIFE INS. CO. DELAWARE NATIONAL LIFE INS. CO. DELCHAMPS HEALTH AND DENTAL BENEFITS DELHI AMBULANCE ASSOCIATION DELTA BROKERS 0970-00 0547-00 0136-00 1399-00 1631-00 0757-00 CLEARWATER WILMINGTON DOVER NASHVILLE DELHI HARAHAN FL DE DE TN LA LA 33517 19899 19903 37202 71232 70123 DELTA DENTAL 1389-00 LOS ANGELES CA 90057 DELTA DELTA DELTA DELTA DELTA DELTA DELTA 3739-00 3694-00 3991-00 3604-00 3536-00 3795-00 Y795-00 100 COURT AVE/STE 306 POST OFFICE BOX 391 1921 LOS VEGAS BLVD POST OFFICE BOX 660028 POST OFFICE BOX 391 P O BOX 52115 PHOENIX P O BOX 17264 P O BOX 2068 P O BOX 30753 P O BOX 51005 60 E SOUTH TEMPLE P O BOX 45530 P O BOX 41-4043 1323 S MINNESOTA AVE HEALTH & WELFARE FUND P O BOX 860037 P O BOX 1080 P O BOX 809059 P O BOX 809059 100 NORTH JEFFERSON 1500 N MANTUA ST P O BOX 1907 P O BOX 21627 PO DRAWER 310 P O BOX 128 P O BOX 2230 P O BOX 56099 P O BOX 23060 P O BOX 938 4201 MICHOOD BLVD P O BOX 9525 P O BOX 740810 1600 UTICA AVE S SUITE 900 P O BOX 899 12TH & MARKET ST POST OFFICE BOX 933 P O BOX 1140 P O BOX 596 5817 CITRUS BLVD SUITE FTG 3700 WILSHIRE BLVD #830 P O BOX 57186 P O BOX 1809 P O BOX 173803 P O BOX 1809 P O BOX 15965 P O BOX 997330 P O BOX 2870 P O BOX 2870 ALPHARETTA DENVER ATLANTA N LITTLE ROCK SACRAMENTO BOISE BOISE GA CO GA AR CA ID ID 30023 80217 30023 72231 95899 83701 83701 DENTAL DENTAL DENTAL DENTAL DENTAL DENTAL DENTAL OF OF OF OF ARKANSAS CALIFORNIA IDAHO IDAHO LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 27 TPL CARRIER FILE LISTING CARRIER NAME DELTA DELTA DELTA DELTA DELTA DELTA DELTA DELTA DELTA DELTA DELTA DELTA DELTA DENTAL DENTAL DENTAL DENTAL DENTAL DENTAL DENTAL DENTAL DENTAL DENTAL DENTAL DENTAL DENTAL OF OF OF OF OF OF OF OF OF OF OF OF OF ILLINOIS IOWA KANSAS KENTUCKY MASSACHUSETTS MICHIGAN MINNESOTA MISSOURI NORTH CAROLINA OKLAHOMA PENNSYLVANIA TENNESSEE VIRGINIA CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP 3825-00 3766-00 3787-00 2604-00 3408-00 3712-00 3952-00 2903-00 3728-00 3326-00 3735-00 3888-00 3805-00 P O BOX 5402 P O BOX 919 P O BOX 789769 9901 LINN STATION RD P O BOX 9695 P O BOX 30416 P O BOX 330 P O BOX 16921 P O BOX 1609 P O BOX 548809 ONE DELTA DRIVE 240 VENTURE CIRCLE 4818 STARKEY ROAD ROANOKE P O BOX 828 P O BOX 16450 1515 POYDRAS ST SUITE 1760 940 E SAHARA AVE 3229 CARONDELET ST P O DRAWER 3557 1235 MISSION STREET 9901 LINN STATION ROAD P O BOX 3711 P O BOX 1418 12090 S HARRELLS FERRY RD #A-B P O BOX 40017 P O BOX 4065 P O BOX 735 P O BOX 1842 5373 S GREEN ST 4TH FLR 3012 19TH STREET P O BOX 262269 POST OFFICE BOX 19030 10 SOUTH MAIN P O BOX 45530 P O BOX 631 P O BOX 128 P O BOX 44309 P O BOX 6480 1400 CANAL BLVD 750 N DIAMOND BAR BLVD P O BOX 2230 3701 KIRBY DR/STE 1050 IRMC P O BOX 4705 12946 DAIRY ASHFORD STE 360 11837 BRICKSOME AVE SUITE A LISLE ANKENY WICHITA LOUISVILLE BOSTON LANSING MINNEAPOLIS ST.LOUIS MINNEAPOLIS OKLAHOMA CITY MECHANICSBURG NASHVILLE IL AK KS KY MA MI MN MO MN OK PA TN VA 60532 50021 67278 40223 02114 48909 55440 63105 55440 73154 17055 37228 24018 STEVENS POINT NORTH LITTLE ROCK NEW ORLEANS WI AR LA 54481 72231 70157 LAS VEGAS NEW ORLEANS BATON ROUGE SAN FRANCISCO LOUISVILLE LAMIRADA TOMBALL BATON ROUGE NV LA LA CA KY CA TX LA 89104 70115 70821 94103 40223 90637 77377 70816 BATON ROUGE JACKSONVILLE DENHAM SPRINGS MEMPHIS SALT LAKE CITY LA FL LA TN UT 70835 32231 70727 38101 84123 METAIRIE PLANO JACKSONVILLE SALT LAKE CITY LA TX FL UT 70002 75026 32245 84145 MANSFIELD HACKBERRY JACKSONVILLE HARRISBURG NEW ORLEANS DIAMOND BAR NEW ORLEANS HOUSTON MONROE LA LA FL PA LA CA LA TX LA 71052 70645 32231 17112 70112 91765 70176 77098 71211 SUGARLAND TX 77478 BATON ROUGE LA 70816 DELTA DENTAL OF WISCONSIN DELTA DENTAL PLAN OF ARKANSAS INC DELTA HEALTH NETWORK 3490-00 1668-00 0869-00 DELTA INS ADMNISTRATORS INC DELTA LIFE INS DELTA NATIONAL LIFE INSURANCE CO DELTA SERVICE PLANS INS. CO. DELTA USA DENNY'S GROUP BENEFITS DENT-ALL PLAN INC DENTA CARE 1630-00 1932-00 2648-00 0137-00 2594-00 1124-00 2893-00 1478-00 DENTAL DENTAL DENTAL DENTAL DENTAL 1633-00 2921-00 2088-00 2587-00 3859-00 INSURANCE ADMINISTRATORS, INC MAINTENANCE ORGANIZATION MANAGEMENT NETWORK OF AMERICA SELECT DENTAMAX INC DENVER HEALTH MEDICAL PLAN DEPENDABLE LIFE INS. CO. DESERET HEALTHCARE 2726-00 H560-80 0138-00 1763-00 DESOTO PARISH SCHOOL BOARD EMPLOYEES BENEFITS DEVALL TOWING & BOAT SERVICE OF HACKBERRY DEXTER INSURANCE DH EVANS DIALYSIS CLINIC INC (SELF-INSURED) DIAMOND BENEFITS LIFE INSURANCE COMPANY DIAMOND OFFSHORE DRILLING INC DIGICON EMPLOYEE BENEFITS PLAN DIMENSIONAL 1887-00 2699-00 3808-00 3733-00 2830-00 1471-00 2589-00 2803-00 1434-00 DINA DENTAL PLAN 3842-00 DINA, INC (DENTAL INSURANCE ADMINISTRATORS INC) 1426-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 28 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP DIRECTIONAL WIRELINE SERVICES DISCOVERY CHEMICALS (SELF-INSURED) DISNEY GROUP INSURANCE DISTRICT 2 MEBA AMO MEDICAL PLAN DIVERSIFIED GROUP BROKERAGE CORP DIVERSIFIED GROUP INS DIVERSIFIED HEALTH CONCEPT CORP DIVERSIFIED INDUSTRIAL GROUP HEALTH PLAN 2285-00 2623-00 1685-00 2559-00 2366-00 0832-00 1814-00 1781-00 SHREVEPORT PORT ALLEN LAKE BUENA VISTA DAVIA MARLBOROUGH METAIRIE SCOTTSDALE PARAMOUNT LA LA FL FL CT LA AZ CA 71137 70767 32830 33004 06447 70011 85261 90723 DIVERSIFIED PHARMACEUTICAL SERVICES INC DIXIE NATIONAL LIFE INS. 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OF WAUSAU 1156-00 1088-00 0144-00 1943-00 2429-00 3119-00 2075-00 3659-00 1900-00 3455-00 0717-00 0145-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 30 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP EMPLOYERS MODERN LIFE CO. EMPLOYERS MUTUAL INC EMRO MARKETING COMPANY 0146-00 3310-00 2675-00 DES MOINES STUART SPRINGFIELD IA FL OH 50503 34994 45501 EMS ADMINISTRATIVE SERVICES CORP ENERGY SERVICE CORP INC 2371-00 1472-00 FORT WORTH HOUSTON TX TX 76102 77074 ENERGY VENTURES INC-MALLARD BAY DRILLING ENSEARCH EMPLOYEE BENEFIT TRUST ENTERCORP ENTERPRISE LIFE INS. CO. 2254-00 1228-00 1078-00 0147-00 NEW IBERIA HOUSTON SHREVEPORT IRVING LA TX LA TX 70562 77210 71120 75062 ENTRUST ENVISION RX OPTIONS EPIC HEALTHCARE GROUP 2557-00 3683-00 1558-00 HOUSTON TWINSBURG COSTA MESA TX OH CA 77244 44087 92628 EPOCH EQUICOR EQUICOR EQUICOR EQUICOR EQUIFAX 2890-00 2302-00 1125-02 1125-01 1125-00 2798-00 POST OFFICE BOX 712 700 CENTRAL PKWY BENEFITS DEPARTMENT P O BOX 6200 1115 W LANCASTER AVE 9494 SOUTHWEST FREEWAY SUITE 300 P O BOX 13530 P O BOX 4271 P O BOX 21976 4545 FULLER DRIVE STE. 230 P O BOX 441588 2181 E AURORA RD/STE 201 MEDICAL BENEFIT TRUST DIV P O BOX 661700 10795 WATSON ROAD P O BOX 3310 STATION D P O BOX 529 P O BOX 34337 P O BOX 2005 5001 SPRING VALLEY RD STE 1000E P O BOX 16531 P O BOX 2481 INDIVIDUAL HEALTH CENTER POST OFFICE BOX 2460 1285 AVE OF AMERICAS 604 LOCUST STREET P O BOX 34337 P O BOX 720460 1320 LAKE STREET POST OFFICE BOX 2900 P O BOX 1639 4527 N 16TH STREET SUITE 102 519 DENNIS DRIVE P O BOX 6702 P O BOX 12184 P O BOX 5001 POST OFFICE BOX 5047 P O BOX 77 P O BOX 31352 P O BOX 659777 P O BOX 5756 2025 RIVERSIDE DR P.O. 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EXECUTIVE RISK CONSULTANTS INC EXPRESS SCRIPT 2185-00 3518-00 2555-00 0758-00 0153-00 3777-00 3575-00 H451-40 0969-00 0909-00 0154-00 1407-00 3897-00 EXPRESS SCRIPT 2133-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 31 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP EXXON MEDICARE SUPPLEMENT EYE CARE PLAN OF AMERICA F.A. RICHARD & ASSOCIATES INC FALCON CLAIMS SERVICE, INC. 0711-00 3279-00 2844-00 2477-00 HOUSTON MASON METAIRIE NEW ORLEANS TX OH LA LA 77032 45040 70011 70130 FALLON FAMILY FAMILY FAMILY FAMILY FAMILY FAMILY 3391-00 2524-00 1876-00 3280-00 0155-00 3915-00 3113-00 15710 J.F.K. 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CO. LIFE INSURANCE COMPANY MANAGED CARE-FMC FARA BENEFIT SERVICES INC FARM & RANCH LIFE INS. CO., INC. FARM AND HOME LIFE INS. CO. FARMERS GRAIN FARMERS HEALTH AGENCY INSURANCE FARMERS INSURANCE FARMLAND INDUSTRIES INC FARMLAND MID SOUTH HEALTH PLAN FARWEST AMERICAN ASSURANCE CO. FCE BENEFITS FDIC / NCAS FEDERAL CONTRACT EMPLOYEES HLTH & WELFARE FND FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM FEDERAL EXPRESS CORP FEDERAL HOME LIFE INS. CO. FEDERAL LIFE INS. CO. (MUTUAL) FEDERAL MOGUL HEALTH CARE SYSTEM FEDERATED LIFE INS. CO. FEDERATED MUTUAL INSURANCE COMPANY FELRA & UFCW HEALTH & WELFARE FUND FEWELL AND ASSOCIATES FIDELITY AND GUARANTY LIFE INS. CO. FIDELITY BANKERS LIFE INS. CO. FIDELITY FEDERAL LIFE INS. CO., INC. 2867-00 0157-00 0156-00 1486-00 1513-00 1209-00 2090-00 3019-00 0158-00 3507-00 0984-00 2425-00 2226-00 1081-00 0159-00 0160-00 2785-00 0161-00 2127-00 1808-00 1370-00 0163-00 0162-00 2427-00 FIDELITY FIDELITY FIDELITY FIDELITY FIDELITY FIDELITY 3616-00 1573-00 0164-00 0165-00 0166-00 1496-00 FIDUCIARY COMPANY FIRE & CASUALTY INTERSTATE LIFE INS. CO. LIFE INS. CO. MUTUAL LIFE INS. CO., THE SECURITY INS. CO. FIDELITY SECURITY LIFE INS. CO. FIDELITY TIRE BENEFITS FUND FILDCREST CANNON INC FINANCIAL ADMINISTRATION CORPORATION FINANCIAL ASSURANCE, INC. FINANCIAL FIDELITY LIFE INS. CO. 0167-00 2551-00 2879-00 1099-00 0168-00 0169-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 32 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP FINANCIAL INSTITUTIONS GROUP FINANCIAL SECURITY LIFE OF LA FINCH BENEFIT PLAN FIRE BOSS OF LA. (SELF-INSURED) FIREMAN'S AMERICAN LIFE INS. CO. FIREMANS INSURANCE FIRESIDE MUTUAL LIFE FIRESTONE TIRE & RUBBER COMPANY FIRST ADMINISTRATORS FIRST ADMINISTRATORS FIRST ALLMERICA 1329-00 0170-00 1250-00 1990-00 0171-00 0865-00 0735-00 0920-00 3308-00 3422-00 2954-00 BREAUX BRIDGE SHREVEPORT SHREVEPORT NEW IBERIA SAN RAFAEL SAN DIEGO SHREVEPORT AKRON SIOUX CITY SIOUX CITY ITASCA LA LA LA LA CA CA LA OH IA IA IL 70517 71130 71102 70560 94911 92138 71130 44314 51102 51102 60143 FIRST FIRST FIRST FIRST 3239-00 0172-00 1743-00 2126-00 P O BOX 1180 6001 FINANCIAL PLAZA 3811 GILBERT AVE 1503 WEEKS ISLAND RD 1600 LOS GAMOS DRIVE PO BOX 85566 P O BOX 33999 1200 FIRESTONE PARKWAY P O BOX 9900 P O BOX 9900 333 PIERCE RD SUITE 310 P O BOX 3865 POST OFFICE BOX 3258 P O BOX 879 3636 COPLEY RD/STE 201 P O BOX 4138 P O BOX 737 12940 N HWY 183 P O BOX 381686 110 GIBRALTER RD/STE 116 POST OFFICE BOX 1280 POST OFFICE BOX 618 210 BARONNE ST POST OFFICE BOX 9249 400 S. W. SIXTH AVENUE 10621-B OAK HILL PARKWAY POST OFFICE BOX 19685 P O BOX 873 P O BOX 14724 3200 HIGHLAND AVE 11301 W LAKE PARK DR P O BOX 389 P O BOX 5279 POST OFFICE BOX 26841 P O BOX 21116 7 CLAYTON STREET P O BOX 23755 POST OFFICE BOX 30297 POST OFFICE BOX 2941 201 GLENDA STREET 3200 HIGHLAND AVE P O BOX 1268 6001 FINANCIAL PLAZA 300 EAST FALL CREEK BLVD. P O BOX 690450 P O BOX 450 P O BOX 8077 P O BOX 2697 P O BOX 305154 NEW HYDE PARK BATON ROUGE ANDERSON ARKON NY LA IN OH 11040 70821 46015 44321 TOPEKA AUSTIN BIRMINGHAM HORSHAM LYNCHBURG COLUMBIA NEW ORLEANS SALT LAKE CITY PORTLAND BATON ROUGE NEW ORLEANS URBANA LEXINGTON DOWNERS GROVE MILWAUKEE DUBUQUE TORRANCE OKLAHOMA CITY SHREVEPORT MONTGOMERY OAKLAND RALEIGH LITTLE ROCK RAYVILLE DOWNERS GROVE TIFTON SHREVEPORT INDIANAPOLIS SAN ANTONIO PUEBLO WAUSAU WICHITA NASHVILLE WAUSAU KS TX AL PA VA MO LA UT OR LA LA IL KY IL WI IA CA OK LA AL CA NC AR LA IL GA LA IN TX CO WI KS TN WI 66601 78750 35238 19044 24505 65205 70160 84109 97204 70810 70179 61803 40512 60515 53224 52004 90510 73126 71154 36104 94623 27612 72203 71269 60515 31793 71130 46205 78269 81002 54402 67201 37230 54022 AMERICAN ASSURANCE LIFE OF AMERICA BENEFIT CORP BENEFITS AGENCY INC FIRST BENEFITS INC FIRST CARE INSURANCE FIRST CAROLINA CARE FIRST CHOICE INS CO FIRST COLONY LIFE INS. CO. FIRST COLUMBIA LIFE INS. CO. FIRST COMMERCE CORPORATION,FIRST NBC FIRST CONTINENTAL LIFE AND ACCIDENT INS. CO. FIRST FARWEST LIFE INS. CO. FIRST FIDELITY LIFE INSURANCE COMPANY FIRST FINANCIAL LIFE INS. CO. FIRST GUARD HEALTH PLAN FIRST HEALTH FIRST HEALTH FIRST HEALTH FIRST HEALTH NETWORK FIRST INTEGRATED HEALTH FIRST LIFE ASSURANCE CO. FIRST NATIONAL BANK OF SHREVEPORT FIRST NATIONAL LIFE INS. CO. FIRST PACIFIC LIFE INSURANCE CO FIRST PROTECTION LIFE INS. CO. FIRST PYRAMID LIFE INS. CO. OF AMERICA, THE FIRST REPUBLIC BANK FIRST RX FIRST SOUTHEAST RISK FIRST UNITED LIFE INS. CO. FIRSTMARK STANDARD LIFE INS. CO. FISERV HEALTH FISERV HEALTH FISERV HEALTH FISERV HEALTH-KANSAS FISERV HEALTH-TENNESSEE FIZER V HEALTH 1246-00 3293-00 3973-00 1474-00 0173-00 0174-00 1239-00 0175-00 0176-00 1786-00 0177-00 3282-00 3819-00 3565-00 2307-00 3699-00 2634-00 0178-00 0894-00 0180-00 1640-00 0181-00 0182-00 2562-00 3392-00 0796-00 0183-00 0179-00 3371-00 3435-00 3434-00 3303-00 3229-00 3656-00 P O B OX 8077 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 33 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP FLEET RESERVE ASSOCIATION FLEMING GUARDIAN GROUP FLEX PLUS FLEX-LINC HEALTH PLAN FLEXMED FLEXMED FLORIDA COMMERCIAL TRUST FLORIDA HEALTH ALLIANCE FLORIDA HOSPITAL HEALTHCARE SYSTEM FLORIDA LIFE INS. CO. FLORIDA WEST COAST TRAVEL TRADES 2176-00 1481-00 1470-00 1224-00 3715-00 3663-00 1646-00 2248-00 3711-00 0184-00 2497-00 DES MOINES OKLAHOMA CITY HAMPTON MARYLAND HEIGHTS RICHARDSON CHARLESTON MIAMI JACKSONVILLE ORLANDO MIAMI TAMPA IA OK NH MO TX SC FL FL FL FL FL 50398 73126 03842 63043 75085 29413 33100 32247 32553 33143 33612 FMH BENEFIT SERVICES FMH BENEFITS, INC FOOD LION BENEFIT PLAN FORD LIFE INS. CO. FOREIGN MISSION BOARD OF THE SO. BAPTIST CONV. FOREIGN SERVICE BENEFIT PLAN 3295-00 2960-00 2339-00 0185-00 2504-00 3266-00 OVERLAND PARK OVERLAND PARK CHARLESTON DEARBORN RICHMOND WASHINGTON KS KS WV MI VA DC 66225 66225 25339 48121 23230 20415 FOREMOST LIFE INS. CO. FOREST OIL CORP. MEDICAL & DENTAL PLANS FORREST T JONES & COMPANY FORTIS BENEFITS 0186-00 2725-00 3925-00 2114-00 GRAND RAPIDS ENGLEWOOD KANSAS CITY KANSAS CITY MI CO MO MO 49501 80112 64141 64141 FOUNDATION BENEFITS ADMINISTRATORS FOUNDATION HEALTH 3375-00 2567-00 AUSTIN NEW ORLEANS TX LA 78730 70130 FOUNDERS LIFE ASSURANCE CO. OF FL FOUNTAIN VALLEY MEDICAL CENTER (HMO) FHP INC FOUNTAINHEAD ADM. FOX EVERETT INC. FRANK GATES SERVICE CO;DELTA QUEEN 0187-00 2577-00 2723-00 1367-00 0918-00 TAMPA FOUNTAIN VALLEY BIRMINGHAM JACKSON COLUMBUS FL CA AL MS OH 33601 92708 35202 39205 43216 FRANK'S CASING CREW & RENTAL TOOLS INC FRANKLIN LIFE INS. CO., THE FREEDOM LIFE FREEDOM LIFE INS CO OF AMERICA FREEPORT-MCMORAN INC 2272-00 0188-00 1421-00 3623-00 2578-00 LAFAYETTE SPRINGFIELD LOUISVILLE FORT WORTH RICHARDSON LA IL KY TX TX 70505 62705 40224 76102 75083 FRESENIUS MEDICAL CARE HEALTH PLAN FRINGE BENEFIT PLANS INC-HERMITAGE INSURANCE FRINGE BENEFITS MANAGEMENT COMPANY FUGRO INC/EMPLOYEE BENEFIT SERVICES FUNDING BENEFITS (LAFAYETTE PARISH GOVT ) FUNDING BENEFITS ADMINISTRATIVE SERVICES G & G DISTRIBUTORS CORP G E PENSIONER INS G.M. UNDERWRITERS G.M.P.-EMPLOYERS RETIRE TRUST GA/PPO 3798-00 0800-00 3318-00 2636-00 0927-00 0760-00 0709-00 0763-00 2071-00 1787-00 2155-00 400 LOCUST ST/8TH FLOOR P O BOX 26647 P O BOX 6000 SO.AMERICAN INDUSTRIAL DR P O BOX 853925 P O BOX 22557 P O BOX 432773 P O BOX 10269 P O BOX 536847 6600 RED ROAD ADMINISTRATIVE SERV. INC 12421 N FLORIDA/STE D-203 P O BOX 25946 P O BOX 25946 P O BOX 11604 THE AMERICAN ROAD P O BOX 6767 OFFICE OF PERSONNEL MGMT 1900 E STREET NW POST OFFICE BOX 2450 16 INVERNESS PLACE E BLDA P O BOX 418131 PROSTAFF INC P O BOX 419876 6300 BRIDGEPOINT PKWY 605 POYDRAS ST STE 2220 POST OFFICE BOX 1571 9930 TALBERT AVE P O BOX 2568 P O BOX 188 STEAMBOAT BENEFIT TRUST PO BOX 16580 P O BOX 51729 FRANKLIN SQUARE P O BOX 24294 801 CHERRY ST/UNIT 33 P O BOX 833843 1661 GATEWAY BLVD P O BOX 741107 3811 GILBERT ST P O BOX 730561 P O BOX 70100 PO BOX 7325 2324 HWY 316 P O BOX 6295 P O BOX 7777 P O BOX 5004 5245 BIG PINE WAY S.E. 639 LOYOLA AVE SUITE 860 HOUSTON SHREVEPORT ORMOND SHREVEPORT METAIRIE HOUMA BOSSIER UTICA ROCHESTER FORT MEYERS NEW ORLEANS TX LA FL LA LA LA LA NY MI FL LA 77274 71104 32173 71137 70010 70364 71171 13503 48308 33907 70113 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 34 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP GALAXIA LIFE INSURANCE CO 1560-00 DALLAS TX 75749 GALAXY MARINE SERVICE EMPLOYEE BENEFIT TRUST GALBRAITH & GREEN 2553-00 0510-00 PATTERSON HOUSTON LA TX 70392 77067 GALLAGER-BASSETT GALLAGHER BENEFITS GALLIANO MARINE SERVICE HEALTH INSURANCE PLAN GARAN GARCO DENTAL GARDEN STATE LIFE INS. CO. GARDNER & WHITE GARDNER DENVER 1728-00 3085-00 2784-00 1817-00 2794-00 0189-00 0511-00 3200-00 SAN ANTONIO LISLE GALLIANO KAPLAN CARMEL WASHINGTON INDIANAPOLIS TX IL LA LA IN DC IN IA 78265 60532 70354 70548 46032 20076 46240 52004 GATEWAY HEALTH PLAN 3156-00 PITTSBURGH PA 15219 GATHINGS INSURANCE SERVICES GEHA GEHA (PCIP) GEICO GENERAL INSURANCE GEISENGER HEALTH PLAN GEM INSURANCE GENELCO GENERAL AMERICAN GENERAL AMERICAN LIFE INSURANCE COMPANY GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS GENERAL ELECTRIC GROUP ADMINISTRATORS GENERAL LIFE AND ACCIDENT INSURANCE CO GENERAL MILLS INC GENERAL SERVICES LIFE INS. CO. GENERATING HEALTHCARE GENESCO INC GENMAR INDUSTRIES CORP GROUP SYSTEMS GENWORTH FINANCIAL GENWORTH LIFE AND HEALTH INSURANCE GEOPHYSICAL SERVICE INC 3447-00 3593-00 3855-00 3263-00 2729-00 2909-00 2013-00 0974-01 0974-00 2360-00 3070-00 0902-00 2018-00 0190-00 3838-00 1853-00 2153-00 3622-00 3368-00 1440-00 RIDGELAND INDEPENDENCE INDEPENDENCE WASHINGTON DANVILLE LUBBOCK FT WORTH ST LOUIS KENNETT SILVER SPRINGS ARLINGTON FORT WORTH MINNEAPOLIS WASHINGTON HOUSTON NASHVILLE LIVONIA CLEARWATER LYNCHBURG DALLAS MS MO MO DC PA TX TX MO MO MD TX TX MN DC TX TN MI FL VA TX 39158 64051 64061 20076 17822 79453 76101 63178 63857 20914 76015 76109 55440 20006 77274 37202 48151 33757 24506 75265 GEORGE H LEHLEITNER CO INC GEORGE WASHINGTON LIFE INS. CO. GEORGETOWN BENEFITS INSURANCE 0932-00 0191-00 1032-00 NEW ORLEANS JACKSONVILLE ATLANTA LA FL GA 70183 32203 30358 GEORGIA HEALTHCARE PARTNERSHIP INC 2658-00 SAVANNAH GA 31406 GEORGIA INTERNATIONAL 1082-00 JACKSON MS 39216 GEORGIA INTERNATIONAL LIFE INS.CO. GEORGIA LIFE AND HEALTH INS. CO. GEORGIA PACIFIC CORPORATION (PAPER-GROUP INS) GERBER LIFE INS. CO. GILSBAR GILSBAR 1093-00 1429-00 1072-00 0192-00 3743-00 3439-00 P O BOX 749028 LBJ FREEWAY P O BOX 189 350 GLENBOROUGH DR. SUITE 100 P O BOX 34297 P O BOX 5227 17483 E MAIR ST 302 CLAVEY MEAUX RD P O BOX 1917 GEICO PLAZA, 6T P O BOX 40619 P O BOX 389 DUBUQUE TWO CHATHAM CENTER SUITE 500 P O BOX 960 P O BOX 4665 P O BOX 300 ONE GEICO PLAZA DANVILLE OFFICE BLDG P O BOX 53010 P O BOX 901030 P O BOX 14458 719 TEACO ROAD P O BOX 4759 P O BOX 150809 P O BOX 11218 P O BOX 1113 1701 PENNSYLVANIA AVE NW P O BOX 740949 RM 436 GENESCO PARK P O BOX 2908 P O BOX 10821 P O BOX 40011 SELF INSURED P O BOX 655621 PO BOX POST OFFICE BOX 4214 HOME DEPOT PO BOX 720677 7135 HODGSON MEMORIAL DR SUITE 9 C/O ENGINEERING SERVICES P O BOX 4632 PO BOX 7325 P O BOX 1676 P O BOX 520 66 CHURCH STREET P O BOX 5470 P O BOX 9802 ATLANTA ATLANTA CROSSETT WHITE PLAINS COVINGTON LUBBOCK GA GA AR NY LA TX 30357 30301 71635 10601 70434 79408 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 35 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP GILSBAR INC GLENWOOD REGIONAL MEDICAL CENTER GLOBAL EXCEL MANAGEMENT GLOBAL HEALTH GLOBAL INSURANCE MANAGEMENT & CONSULTANTS GLOBAL MARINE,INC.HEALTH CARE PLAN GLOBAL SANTA FE GLOBE LIFE & ACCIDENT INS. CO. 0935-00 1994-00 3916-00 3746-00 1307-00 1351-00 3505-00 0193-00 COVINGTON MONROE BEEBE PLAIN OKLAHOMA CITY ROANOKE HOUSTON EL PASO OKLAHOMA CITY LA LA VT OK VA TX TX OK 70434 71207 05823 73101 24012 77218 79998 73184 GLOBE LIFE INS. CO. GM SOUTHWEST GODWINS BOOKE & DICKENSON GOLDEN RULE GOLDEN RULE GOLDEN RULE INSURANCE GOLDEN STATE MUTUAL LIFE INS. CO. 0194-00 3497-00 2608-00 3639-00 0195-00 0784-00 0196-00 CHICAGO FRISCO WINSTON-SALEM INDIANAPOLIS LAWRENCEVILLE LAFAYETTE LOS ANGELES IL TX NC IN IL LA CA 60601 75034 27102 46278 62439 70503 90054 GOLDEN TRIANGLE HEALTHCARE MGMT GOOD HEALTH TRUST GOOD SAMARITAN PROGRAM GOODYEAR TIRE AND RUBBER CO GOVERNMENT EMPLOYEES HOSPITAL ASSOCIATION GOVERNMENT PERSONNEL MUTUAL LIFE INS. CO. GRAND CASINO HEALTH PLAN GRAND ISLE SHIPYARD INC GRASSO CORPORATION 2840-00 1392-00 1615-00 1046-00 0727-00 0197-00 2596-00 2413-00 2359-00 NEDERLAND LAKELAND BEECH GROVE AKRON INDEPENDENCE SAN ANTONIO MINNEAPOLIS GRAND ISLE HOUSTON TX FL IN OH MO TX MN LA TX 77627 33802 46107 44316 64051 78216 55440 70358 77042 GRAY INS CO GREAT AMERICAN CORPORATION BENEFIT SERVICE GREAT AMERICAN LIFE INSURANCE CO. GREAT AMERICAN RESERVE INS. CO. GREAT CENTRAL LIFE INS. CO. 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CO. SOUTHERN LIFE INS. CO. SOUTHERN OIL & GAS INC SOUTHERN PAPER COMPANY GREAT SOUTHWEST LIFE INS. CO. GREAT WEST HEALTH CARE GREAT WEST HEALTH CARE 0203-00 3553-00 3474-00 GREAT WEST HEALTH PLAN GREAT WEST LIFE HEALTH GREAT WEST/PHCS 1935-00 2151-00 3654-00 GREAT WESTERN LIFE 2073-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 36 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP GREAT-WEST CARE 1929-00 ATLANTA GA 30326 GREAT-WEST CARE HEALTH PLAN GREAT-WEST LIFE ASSURANCE CO., THE GREEN TREE ADMINISTRATORS GREEN TREE ADMINISTRATORS GREY WOLF DRILLING 1815-00 0204-00 1485-00 3880-00 1723-00 TAMPA DENVER CARNEGIE BEAUMONT HOUSTON FL CO PA TX TX 33631 80201 15106 77726 77056 GREYHOUND LINES INC GROUP ADMINISTRATORS INC GROUP ADMINISTRATORS LTD GROUP AND PENSION ADMINISTRATORS GROUP AND PENSION ADMINISTRATORS INC GROUP BENEFIT ADMINISTRATORS GROUP BENEFITS UNLIMITED 1095-00 1958-00 3456-00 3546-00 2610-00 1680-00 2882-00 PHOENIX DALLAS SCHAUMBURG DALLAS RICHARDSON RIVER EDGE ARLINGTON HEIGHTS AZ TX IL TX TX NJ IL 85064 75231 60173 75374 75080 07661 60004 GROUP DENTAL SERVICES GROUP EXECUTIVE MARKETING INC 1315-00 3073-00 NORTH BETHESDA TAMPA MD FL 20895 33675 GROUP GROUP GROUP GROUP GROUP 3363-00 3664-00 2430-00 0751-00 3511-00 3340 PEACHTREE RD NE SUITE 2295 P O BOX 31251 POST OFFICE BOX 1080 P O BOX 759 P O BOX 7306 1980 POST OAK BLVD #1150 P O BOX 32419 10440 N CENTRAL EXPY 450 E REMINGTON RD P O BOX 749075 300 MUNICIPAL DR 70 GRAND AVE 3800 N WILKE SUITE 200 11301 ROCKVILLE PIKE CCN PPO P O BOX 5190 P O BOX 370 P O BOX 34585 P O BOX 34750 221 PARK AVE S 550 MARYVILLE CENTRE DRIV SUITE 300 111 CORPORATE OFFICE DR. 4 P O BOX 431890 9201 E BLOOMINGTON FWY 205 W WACKER DR ONE POYDRAS PLAZA 639 LOYOLA AVE/STE 1360 10877 WATSON ROAD P O BOX 20593 P O BOX 1180 TENSAS MEMORIAL HOSPITAL TPA,INC BOX N P O BOX 100043 P O BOX 450367 P O BOX 4503 8801 INDIAN HILLS DR 530 RIVER OAKS WEST P O BOX 1144 P O BOX 3248 POST OFFICE BOX 2231 P O BOX 2459 P O BOX 8007 P O BOX 8024 P O BOX 385012 POST OFFICE BOX 3892 1601 WEST ALABAMA GALLIANO SEATTLE SEATTLE NEW YORK 3 ST LOUIS LA WA WA NY MO 70354 98124 98124 10027 63141 EARTH CITY MO 63045 SO MIAMI BLOOMINGTON CHICAGO NEW ORLEANS FL MN IL LA 33243 55420 60606 70113 ST. 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GUARDIAN GUARDIAN GUARDIAN GUIDESTAR HEALTH SYSTEM GULF ATLANTIC LIFE INS. CO. GULF COAST LINES EMPLOYEES HOSPITAL ASSC 3460-00 1799-00 2002-00 1973-00 0205-00 0206-00 0883-00 0207-00 3534-00 0208-00 1909-00 2941-00 0209-00 1313-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 37 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP GULF GULF GULF GULF GULF GULF 2078-00 0705-00 2314-00 0211-00 2347-00 2810-00 5656 S STAPLES ST/STE 330 P O BOX 15349 P O BOX 14977 POST OFFICE BOX 1050 P O BOX 14449 P O BOX 8570 3616 S I-10 SERVICE ROAD OF THE SOUTH P O BOX 2352 5615 CORPORATE BLVD STE 5A 5615 CORPORATE BLVD P O BO 1398 P O BOX 3857 2325 WEYMOUTH DR STE A POST OFFICE DRAWER 157 P O BOX 120539 ONE PLAZA EAST SUITE 1100 P O BOX 863 TOWER LIF BLDG CORPUS CHRISTI BATON ROUGE JACKSON JACKSONVILLE BATON ROUGE METAIRIE TX LA MS FL LA LA 78411 70895 39236 32201 70898 70011 NEW ORLEANS LA 70183 BATON ROUGE LA 70808 BATON ROUGE HOUMA HOUMA BATON ROUGE LA LA LA LA 70808 70361 70361 70809 MARKSVILLE NASHVILLE MILWAUKEE LA TN WI 71351 37212 53202 INDIANAPOLIS SAN ANTONIO ORLANDO GREENVILLE LAS VEGAS ROANOKE SHREVEPORT COSTA MESA IN TX FL SC NV VA LA CA 46206 78205 32887 29606 89104 24022 71130 92626 DUNCAN WESTMONT LAFAYETTE IRVING OK IL LA TX 73534 60559 70506 75039 COVINGTON BATON ROUGE SCOTTSDALE LA LA AZ 70433 70821 85250 TAMPA DAYTON SALT LAKE CITY HOUSTON FL OH UT TX 33631 45401 84130 77002 ARLINGTON HARTFORD HARTFORD QUINCY STATELINE HONOLULU DES MOINES WESTERVILLE TX CT CT MA NV HI IA OH 76011 06115 06115 02269 89449 96808 50322 43081 EMPLOYERS TRUST PLAN ADMIN GROUP SERVICE GUARANTY HEALTH INSURANCE LIFE INS. CO. SERVICES INC SOUTH ADMINISTRATORS GULF SOUTH BEVERAGE EMPLOYEES BENEFIT PLAN 1001-00 GULF SOUTH HEALTH PLAN 1200-00 GULF GULF GULF GULF 1131-00 3533-00 3026-00 3319-00 SOUTH HEALTH PLAN SOUTH RISK SERVICES SOUTH RISK SERVICES STATES LTAC GULFCO LIFE INS. CO. GULFSOUTH PRINTING & SPECIALTIES INC GUSTCO GROUP INSURANCE 0210-00 1339-00 1008-00 H C C LIFE INS CO H.B. ZACHRY CO & AFFILIATES GROUP MEDICAL PLANS H.B.J. INSURANCE CO H.D.R. EMPLOYEES BENEFITS ADMINISTRATION H.E.R.E.I.U. WELFARE FUND H.L. DUKE AND CO. HAAB SECURITY LIFE INS. CO. HALLER ASSOCIATES 3648-00 2262-00 1638-00 2091-00 2437-00 1544-00 0212-00 2788-00 HALLIBURTON CO EMPLOYEES TRUST MED PLAN OFFICE HALLMARK INS ADMIN INC HAMILTON HEALTH PLAN HAMMERMAN & GRAINER INC 1264-00 1401-00 1247-00 3868-00 HAMMONS & ASSOCIATES HANCOCK BANK OF LOUISIANA HARDEN & COMPANY OF ARIZONA 2564-00 1793-00 2993-00 HARMONY HEALTH PLAN OF MISSOURI HARRINGTON BENEFIT SERVICES INC HARRINGTON HEALTH HARRIS COUNTY OFFICE OF RISK MANAGEMENT 3345-00 2679-00 3770-00 2925-00 HARRIS METHODIST HEALTH PLAN HARTFORD LIFE AND ACCIDENT INS. CO. HARTFORD LIFE INS. CO. HARVARD PILGRIM INSURANCE HARVEYS HEALTH CLAIMS MANAGEMENT HAWAII MEDICAL SERVICE ASSOCIATION HAWKEYE NATIONAL LIFE INS. CO. HBS GROUP (HARRINGTON BENEFIT SERVICES) 2573-00 0213-00 0214-00 3306-00 2904-00 1960-00 0215-00 2692-00 P O BOX 5150 1933 LAS VEGAS BLVD SO. 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A P O BOX 6133 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 38 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP HEALTH ADMINISTRATION SERVICES,INC 1423-00 HOUSTON TX 77067 HEALTH HEALTH HEALTH HEALTH HEALTH 1790-00 1632-00 H231-20 0722-00 1968-00 12600 NORTHBOROUGH SUITE 300 P O BOX 22255 2850 WEST GRAND BLVD 2850 WEST GRAND BLVD 5425 BRITTANY DR 4919 MEMORIAL HWY SUITE 100 P O BOX 21109 P O BOX 691987 839 ST CHARLES AVE STE 100 P O BOX 3970 P O BOX 8674 1201 S SHERMAN SUITE 200 5 E JACKSON BLVD 2727 PACES FERRY RD NW SUITE 2-400 233 N MICHIGAN AVE P O BOX 2347 P O BOX 24870 410 N 44TH ST STE 510 P O BOX 273940 P O BOX 45018 P O BOX 224767 P O BOX 1439 P O BOX 2583 P O BOX 922001 8500 NORMANDALE LAKE BLVD 950 E PACES FERRY ROAD NE SUITE 975 P O BOX 69355 P O BOX 130217 P O BOX 307 P O BOX 11088 P O BOX 16707 P O BOX 419104 7 WEST 34TH ST 304 NORTH MAIN ST P O BOX 419104 P O BOX 3369 P O BOX 171823 P O BOX 69349 9494 SOUTHWEST FREEWAY SUITE 300 ONE MONARCH PLACE SUITE 1500 P O BOX 1289 505 S MAIN ST STE 300 SHREVEPORT DETRIOT DETROIT BATON ROUGE TAMPA LA MI MI LA FL 71120 48202 48202 70808 33614 ROANOKE SAN ANTONIO NEW ORLEANS VA TX LA 24018 78269 70130 LAFAYETTE METAIRIE RICHARDSON CHICAGO ATLANTA LA LA TX IL GA 70502 70011 75081 60604 30339 CHICAGO YORK OKLAHOMA CITY PHOENIX IL PA OK AZ 60601 71405 73124 85008 BOCARATON FRESNO DALLAS HENDERSONVILLE HUDSON HOUSTON BLOOMINGTON ATLANTA FL CA TX TN OH TX MN GA 33427 93718 75222 37077 44236 77292 55437 30326 HARRISBURG TYLER LOWELL CHARLOTTE JACKSON ST LOUIS NEW YORK ROCKFORD ST LOUIS COVINGTON MEMPHIS HARRISBURG HOUSTON PA TX MA NC MS MO NY IL MO LA TN PA TX 17106 75713 01854 28220 39236 63141 10001 61101 63141 70434 38187 17110 77074 SPRINGFIELD MA 01144 MINNEAPOLIS ORANGE MN CA 55440 92668 ADVANTAGE ALLIANCE PLAN ALLIANCE PLAN AMERICA AND LIFE INSURANCE CO. 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CO. HERMITAGE HEALTH & LIFE INS. CO. HERTZ CLAIM MANAGEMENT HEWITT, COLEMAN & ASSOCIATES, INC. HIGHLANDS INSURANCE CO HIGHMARK FREEDOM BLUE HIGHMARK SERVICES COMPANY HIGMAN TOWING COMPANY HILB, ROGAL, AND HAMILTON ADMINISTRATORS HILL BROTHERS CONSTRUCTION (SELF INSURED) HILL COUNTRY LIFE INS. CO. OF TX HILL RICHARDS OF LA HILLCREST BENEFITS HILLENBRAND INDUSTRIES (SELF-INSURED) HILLHAVEN CORP 2340-00 3107-00 1596-00 0216-00 0217-00 2445-00 0509-00 1741-00 H979-30 3072-00 2079-00 2381-00 3121-00 0218-00 0782-00 3294-00 2058-00 1346-00 MANSFIELD AUBURNDALE SAN ANTONIO AGOURA HILLS BRENTWOOD OKLAHOMA CITY GREENVILLE HOUSTON CAMP HILL PITTSBURGH ORANGE SAVANNAH FALKNER AUSTIN BATON ROUGE MT DORA BATESVILLE TACOMA LA FL TX CA TN OK SC TX PA PA TX GA MS TX LA FL IN WA 71052 33823 78217 91301 37027 73124 29608 77002 17089 15253 77630 31412 38629 78766 70898 32756 47006 98401 HILLHOUSE ASSOCIATE HILLS PET NUTRITION CO. 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CO. 1352-00 0220-00 METAIRIE NEWARK LA NJ 70002 07192 HOME PROTECTOR HOME TOWN HEALTH HOMELAND HEALTHCARE HOOD INDUSTRIES INSURANCE 1215-00 2999-00 3935-00 1899-00 P O BOX 2888 2 PERIMETER PARK SOUTH SUITE 300 WEST 9701 W HIGGINS RD/STE 360 9101 WESLEYN RD 11422 MIRACLE HILLS DR P O BOX 2878 2755 BRISTOL SUITE 250 P O BOX 919 P O BOX 1730 P O BOX 17339 30851 WEST AGOURA ROAD POST OFFICE BOX 271 P O BOX 24110 POST OFFICE BOX 3808 600 JEFFERSON ST P O BOX 890170 P O BOX 535078 P O BOX 908 P O BOX 9888 P O BOX 131 POST OFFICE BOX 10047 P O BOX 80297 P O BOX 1516 HIGHWAY 46 BENEFITS DEPT CALLER SERV 2264 POST OFFICE BOX 203010 P O BOX 148 NEW ORLEANS HILTON #2 POYDRAS 55 WATER STREET P O BOX 519 P O BOX 98024 8181 SOUTH LEWIS AVE P O BOX 42416 P O BOX 348 P O BOX 9360 707 COMBINED CENTRE P O BOX 91807 P O BOX 1110 1717 RT. 208 DEPT HD 3510 N CAUSEWAY BLVD MET OPERATIONS P O BOX 15244 3400 MACARTHUR DRIVE 240 S ROCK BLVD 909 LAKE CAROLYN PKWY ST P O BOX 17317 ALEXANDRIA RENO IRVING HATTIESBURG LA NV TX MS 71301 89512 75039 38402 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 41 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP HORACE MANN LIFE INS. CO. HORIZON BCBSNJ HORIZON HEALTH CARE EMPLOYEE BENEFIT HORSEMAN'S BENEVOLENT PROTECTION AGENCY HORSESHOE CASINO (SELF-INSURED) HOSPITAL BENEFITS INC HOSPITAL SERVICES OF LOUISIANA HOTEL EMPLOYEES & RESTAURANT EMPLOYEES HOUSING AUTH.OF LAFAYETTE HEALTH BENEFIT PROGRAM 0221-00 3983-00 2662-00 0768-00 2812-00 1159-00 0802-00 2498-00 2237-00 SPRINGFIELD NEWARK ALBUQUERQUE NEW ORLEANS BOSSIER CITY JACKSON BATON ROUGE LAS VEGAS NEW IBERIA IL NJ NM LA LA MS LA NV LA 62715 07101 87190 70119 71111 39236 70898 89104 70562 HOUSING BENEFITS PLAN HOUSTON GENERAL INSURANCE CO HOUSTON INDUSTRIES 2793-00 1085-00 2415-00 DALLAS FORT WORTH HOUSTON TX TX TX 75354 76113 77027 HOWARD TRUCKING COMPANY HTH WORLWIDE HUDSON FOOD EMPLOYEE BENEFIT PLAN HUGHES AIRCRAFT CO. CLAIMS OFFICE HUMANA HUMANA HUMANA HUMANA HUMANA CLAIMS HUMANA CLAIMS (PFFS) HUMANA DENTAL HUMANA GOLD PLUS HUMANA HEALTH BENEFIT OF LA HUMANA HEALTH INS CO OF FLORIDA INC HUMANA HEALTH PLAN INC HUMANA HEALTH PLANS HUMANA MILITARY HUNT PLYWOOD CO. INC (SELF INSURED) HUVAL GROUP PROGRAM HYDE INSURANCE AGENCY I P A APPLE PLAN I.B.U. NATIONAL HEALTH BENEFIT PLAN I.G.A. 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(SELF-INSURED) P O BOX 14338 P O BOX 542814 P O BOX 2932 4300 POST OAK PARKWAY 5 POST OAK BLDG 113 N JEFFERSON 120 5TH AVE P O BOX 230 P O BOX 11000 P O BOX 14604 P O BOX 14601 500 WEST MAIN STREET P O BOX 14635 P O BOX 14610 P O BOX 14601 P O BOX 14611 P O BOX 98 P O BOX 648 P O BOX 19080-F P O BOX 14610 P O BOX 14610 P O BOX 7031 RT 1 BOX 15X P O BOX 1180 1991 CORPORATE AVE P O BOX 97 P O BOX 12245 8725 WEST HIGGINS RD 43 ORLAND SQ, #303 ORLAND P O BOX 4150 7370 CHEF MENTEUR HWY P O BOX 71120 458 W SOUTH ST PO BOX 1389 111 RUE IBERVILLE SUITE 400 85 BAGBY DR STE 216 611 E BROAD ST 4040 MCEWEN/STE 100 P O BOX 273940 P O BOX 167768 P O BOX 10859 BIRMINGHAM LAKE CHARLES DALLAS BOCA RATON IRVING CLEARWATER AL LA TX FL TX FL 35209 70611 75244 33427 75016 33757 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 42 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP IDS LIFE INS. CO. IL WU PMA WELFARE PLAN (COASTWISE) ILA PENSION AND WELFARE FUND ILLINOIS CENTRAL GULF HOSPITAL ASSOCIATION ILLINOIS MUTUAL IMAY LA INC IMCO SERVICES 0222-00 3822-00 2438-00 0806-00 0843-00 3361-00 1005-00 MINNEAPOLIS SAN FRANCISCO NEW ORLEANS HOMEWOOD PEORIA BOSSIER CITY HOUSTON MN CA LA IL IL LA TX 55402 94103 70125 60430 61634 71171 77027 IMERICA LIFE AND HEALTH INSURANCE IMMIGRATION AND CUSTOMS INSURANCE IMPERIAL CALCASIEU HEALTH CARE ALLIANCE IMPERIAL FIRE INSURANCE IMPERIAL PALACE-NPP 3769-00 3202-00 2918-00 2475-00 2853-00 GARDEN CITY AUSTIN LAKE CHARLES OPELOUSAS LAS VEGAS NY TX LA LA NV 11530 78714 70602 70570 89193 INA LIFE INS. CO. INC HEALTH SOLUTIONS INDEMNITY USA INDEPENDENCE ADMINISTRATOR INDEPENDENCE ADMINISTRATORS/IBXTPA INDEPENDENCE LIFE & ACCIDENT INS. CO. INDEPENDENT ADMINISTR INDEPENDENT BENEFITS PLAN INDEPENDENT GROCERS ASSOCIATION 0223-00 3841-00 2390-00 3665-00 4005-00 0226-00 1211-00 1637-00 2074-00 PHILADELPHIA EGAN HOUSTON HORSHAM EAGAN LOUISVILLE MINNETONKA PERU ORLAND PARK PA MN TX PA MN KY MN IN IL 19101 55121 77252 19044 55121 40201 55343 46970 60462 INDEPENDENT HEALTH INDEPENDENT LIBERTY LIFE INS. CO. INDEPENDENT LIFE AND ACCIDENT INS. CO., THE INDESC OF EBAS CO INDIANA FUNERAL INSURANCE TRUST INDIANA/KENTUCKY/OHIO REG. COUNCIL 2612-00 0227-00 0228-00 1800-00 2912-00 4007-00 BUFFALO GRAND RAPIDS JACKSONVILLE LYNDHURST INDIANAPOLIS INDIANAPOLIS NY MI FL NJ IN IN 14221 49502 32276 07071 46260 46242 INDIANAPOLIS LIFE INS. CO. INDREX/QUARLES EMPLOYEES HEALTH BENEFIT PLAN 0229-00 1710-00 INDIANAPOLIS TULSA IN OK 46206 47133 INDUSTRIAL ELECTRONIC SUPPLIES INC 2093-00 SHREVEPORT LA 71105 INDUSTRIAL LIFE INS. CO. INDUSTRIAL TECHNICAL & PROFESSIONAL EMPLOYEES GROUP INGRAM INDUSTRIES INS CO INHEALTH INC 0230-00 1877-00 2166-00 2570-00 DALLAS SAVANNAH NASHVILLE WORTHINGTON TX GA TN OH 75222 31403 37202 43235 INLAND EMPIRE HEALTH PLAN INSEARCH COMPANY 3827-00 1344-00 SAN BERNADINO HOUSTON CA TX 92423 77210 INSIGNIA FINANCIAL GROUP INC INSPECTION SERVICES INC (SELF-INSURED) INSTASERVE SYSTEMS INC INSULATORS LOCAL UNION NO. 112 INSURANCE ADMINISTRATOR OF AMERICA INSURANCE AND RISK MANAGEMENT INSURANCE BENEFIT SERVICE 2249-00 2144-00 1333-00 1828-00 3170-00 1816-00 0792-00 IDS TOWER 814 MISSION ST 2706 S CLAIBORNE AVE 2024 HICKORY RD 300 S W ADAM STREET P O BOX 71120 248 WEST LOOP SOUTH P O BOX 22605 100 GARDEN CITY PLAZA P O BOX 149058 P O BOX 1393 P O BOX 422 P O BOX 97979 HUMAN RESOURCE DEPT 1600 ARCH STREET P O BOX 21456 P O BOX 2465 P O BOX 1010 P O BOX 21974 POST OFFICE BOX 1247 10801 WAYZATA BLVD P O BOX 1149 43 ORLAND SQUARE DR STE 303 511 FARBER LAKES DR 126 OTTAWA AVENUE, N.W. ONE INDEPENDENT DRIVE 160 CHUBB AVE 1311 WEST 96TH CARPENTERS WELFARE FUND P O BOX 421729 POST OFFICE BOX 1230B 7633 E 63RD PLACE STE 500 MEDICAL BENEFIT PLAN 3776 YOUREE DR POST OFFICE BOX 220998 P O BOX 23679 P O BOX 23049 200 EAST CAMPUS VIEW BLVD SUITE 300 P O BOX 10129 CLAIMS PROCESSING P O BOX 4271 BOX 1089 P O BOX 1289 P O BOX 1005 512 CLARENCE STREET P O BOX 5082 P O BOX 41-4043 P O BOX 218969 GREENVILLE AMELIA DELAWARE LAKE CHARLES MT LAUREL MIAMI BEACH HOUSTON SC LA OH LA NJ FL TX 29602 70340 43015 70601 08054 33141 77218 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 43 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP INSURANCE CLAIM SERVICE INSURANCE COMPANY OF NORTH AMERICA INSURANCE DATA ADMINISTRATORS 2224-00 0854-00 0859-00 BIRMINGHAM PHILADELPHIA SANTA ANNA AL PA CA 35243 19101 95401 INSURANCE INSURANCE INSURANCE INSURANCE INSURANCE INSURANCE 2182-00 3750-00 1428-00 2164-00 1577-00 1855-00 P O BOX 43350 1600 ARCH ST 1400 N DUTTON AVE SUITE 15 P O BOX 875 P O BOX 2806 P O BOX 71120 P O BOX 15688 P O BOX 4705 11330 IH 10 WEST SUITE 2100 BOX 2175 P O BOX 90802 P O BOX 12830 P O BOX 15953 P O BOX 998 P O BOX 65887 230 W PRIEN LAKE P O BOX 619070 P O BOX 39119 P O BOX 21456 P O BOX 21456 P O BOX 41779 645 PLAZA WEST BUILDING P O BOX 94785 EMPLOYERS/HEALTH-WELFARE 4151 CHEASAPEAKE ST NW 420 N. SPRUCE STREET 10065 RED RUN BLVD 75 TECHNOLOGY DRIVE MACK CENTRE DRIVE 5445 LA DIERRA DR SUITE 400 P O BOX 9510 720 BLAIR MILL RD 300 S PARK AVE P O BOX 6002 2002 SOUTH WAYSIDE POST OFFICE BOX 14568 POST OFFICE BOX 1907 P O BOX 19108 P O BOX 3559 40 PARKER ROAD 1010 N FINANCE CENTER DR STE 100 P O BOX 55728 174 PENNSYLVANIA AVE N W PO BOX 9306 P O BOX 1326 LOCAL 576 PO BOX 5543 OAKLAND CLINTON BOSSIER CITY AMARILLO MONROE SAN ANTONIO NJ IA LA TX LA TX 07436 52733 71171 79105 71203 78249 MONROE LUBBOCK JACKSON LUBBOCK JAMESVILLE WEST DES MOINES LAKE CHARLES DFW AIRPORT PHOENIX EAGAN EAGAN MEMPHIS LITTLE ROCK CLEVELAND WASHINGTON LA TX MS TX WI IA LA TX AZ MN MN TN AR OH DC 71207 79408 39211 79790 53547 50265 70601 75261 85069 55121 55121 38174 72205 44101 20016 WINSTON-SALEM OWINGS MILLS LOWELL PARAMUS DALLAS NC MD MA NJ TX 27101 21117 01851 07652 75231 WICHITA HORSHAM POMANA KS PA CA 67277 19044 91769 HOUSTON CINCINNATI DES MOINES RALEIGH ENGLEWOOD ELIZABETH TUCSON TX OH IA NC CO NJ AZ 77023 45214 50306 27619 80155 07208 85710 BIRMINGHAM WASHINGTON GARDEN CITY FORT WORTH ALEXANDRIA AL DC NY TX LA 35255 20006 11530 76101 71301 DESIGN ADMINISTRATORS HEALTH MANAGEMENT ADMINISTRATION MANAGEMENT SERVICES RESOURCES MANAGEMENT INC SERVICE CENTER (CARE) INSURANCE SYSTEMS CLAIMS INSURANCE SYSTEMS INC INSURANCE SYSTEMS INC INSURANCE TPA INSURANCE TPA INSURANCE TRUST INSURANCE UNLIMITED INSURDATA INCORPORATED INSURERS ADMINISTRATIVE CORP INSURERS ADMINISTRATORS INSURERS ADMINISTRATORS INSUREX BENEFITS ADMINISTRATORS INC INSURNATIONAL INCORPORATED INSURANCE CO. INSURX INT'L UNION OF OPERATING ENGINEERS & PIPE LINE 1941-00 3856-00 0818-00 3917-00 3918-00 2137-00 2572-00 1656-00 1570-00 0666-00 3666-00 2697-00 1020-00 2128-00 1700-00 INTEGON LIFE INS. CORP. INTEGRATED HEALTH SERVICES INTEGRATED RESOURCES LIFE INS. CO. INTEGRITY LIFE INS. CO. INTEQ 0231-00 2647-00 1810-00 0232-00 3186-00 INTER AMERICAN INSURANCE CORP INTER COUNTY HOSPITALIZATION INTER VALLEY HEALTH PLAN 3088-00 2615-00 3839-00 INTER-CORP.(SCHUMPERT MEDICAL CENTER) INTER-OCEAN INS. CO. INTER-STATE ASSURANCE CO., A MUTUAL CO. INTERACTIVE MEDICAL SYSTEMS INTERCARE INTERCONTINENTAL LIFE INS. CO. INTERGROUP 0973-00 0234-00 0235-00 2523-00 2120-00 0233-00 2102-00 INTERNAT'L UNION & INDUSTRY HEALTH AND BENEFIT FUND INTERNATIONAL ASSOC OF BENEFITS INTERNATIONAL BENEFITS INTERNATIONAL BENEFITS SERVICES CORPORATION INTERNATIONAL BROTHERHOOD OF ELECTRICAL WORK. 2112-00 3597-00 3929-00 1831-00 0906-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 44 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP INTERNATIONAL BROTHERHOOD OF PAINTERS & ALLIED TRADE 2113-00 NEW ORLEANS LA 70127 INTERNATIONAL CLAIMS SERVICES LTD INTERNATIONAL INCORPORATED INTERNATIONAL LONGSHOREMEN'S ASS'N 1541-00 2259-00 1173-00 ATLANTA LITTLE ROCK NEW ORLEANS GA AR LA 30340 72203 70130 INTERNATIONAL LONGSHOREMENS ASSN INTERNATIONAL MEDICAL GROUP INTERNATIONAL MEDICAL GROUP INTERNATIONAL MINERALS AND CHEMICALS CORP INTERNATIONAL OPERATORS UNION ENGINEERS(IOUE) INTERSTATE BRANDS CORP. INTRACORP INTRNATIONAL CATERING ENTERPRISES 3920-00 3975-00 3355-00 0772-00 0889-00 2304-00 2689-00 1757-00 PORT ALLEN INDIANAPOLIS INDIANAPOLIS STERLING NEW ORLEANS OMAHA BELLE CHASSE SEATTLE LA IN IN LA LA NE LA WA 70767 46208 46208 71280 70126 68175 70037 98104 INVERSION IND.INC MED BENEFIT PLAN-THE HEALTH CARD INVESTOR LIFE GROUP INC. INVESTORS DIVERSIFIED INSURANCE CORP INVESTORS GUARANTY LIFE INS. CO. INVESTORS HERITAGE LIFE INS. CO. IOWA BEEF PROCESSORS INC IPMG IRON WORKERS HEALTH & WELFARE PLAN IRON WORKERS HOSPITAL PLAN IRON WORKERS LOCAL 40,361 & 417 UNION SECURITY FUND IRON WORKERS LOCAL 58 WELFARE PLAN 2750-00 1112-00 1242-00 0236-00 0237-00 2253-00 3939-00 1607-00 1686-00 1533-00 1048-00 MT.CLEMONS CHATTANOOGA BATON ROUGE MERCER ISLAND FRANKFORT MADISON ST CHARLES NEW ORLEANS PHILADELPHIA NEW YORK METAIRIE MI TN LA WA KY NE IL LA PA NY LA 48046 37405 70895 98040 40601 68748 60174 70116 19149 10016 70001 IRON WORKERS WELFARE FUND IRON WORKERS WELFARE FUND IRONWORKERS WELFARE PLAN ISPAT ITPE-NMU HEALTH & WELFARE FUND ITS, INC (INTERNATIONAL TOTAL SERVICES) ITT HARTFORD INSURANCE 3649-00 2609-00 0913-00 3251-00 1119-00 2966-00 2022-00 METAIRIE VANDALIA MONROE EAST CHICAGO SAVANNAH CLEVELAND WOODBRIDGE LA OH LA IN GA OH NJ 70001 45377 71211 45312 31403 44131 07095 ITT LIFE INS. CORP. 0224-00 MINNEAPOLIS MN 55426 ITT LYNDON LIFE INS. CO. IVAN SMITH FURNITURE EMPLOYEE BENEFIT TRUST J C PENNEY LIFE INS CO/STONEBRIDGE LIFE INS CO J H WALKER, INC BENEFIT PLAN J P PARLEY CORPORATION J P S HEALTH NETWORK J R H RISK SERVICES J W TERRILL BENEFIT ADMINISTRATORS J.E. MERIT CONSTRUCTORS J.W.CURELL NORTH AMERICAN ADMINISTRATORS JACK A. PARKER & ASSOC. INC. JACK DANIEL MEDICAL EXPENSE BENEFIT PLAN JACK ECKERD CORPORATION CLAIMS DEPARTMENT JACKSON KEARNEY GROUP 0225-00 3297-00 0238-00 3097-00 3285-00 3478-00 1248-00 3437-00 1693-00 2124-00 0527-00 2560-00 1735-00 2422-00 LOCAL UNION 728 10054 I10 SERVICES RD, E 3855 PRESIDENTIAL PARK P O BOX 8061 AF OF L - CIO 2337 TCHOUPITOULAS ST P O BOX 197 P O BOX 88500 2960 N MERIDIAN ST P O BOX 626 7370 CHEF MENTEUR HWY MUTUAL OF OMAHA PLAZA P O BOX 237 800 5TH AVE SUITE 3420 P O BOX 2305 25 CHEROKEE BLVD P O BOX 45597 3003 77TH AVENUE, S.E. POST OFFICE BOX 717 P O BOX 1010 225 SMITH RD 1407 DECATUR ST 6401 CASTOR AVE 451 PARK AVE SOUTH 4200 I-10 SERVICE RD WEST STE 134 2450 SEVERN AVE #305 1470 WORLDWIDE PL PO BOX 4617 3201 WATLING P O BOX 23679 5005 ROCKSIDE RD NJ HEALTH CLAIM OFFICE 90 WOODBRIDGE CENTER SHELARD TOWER, STE. 600 600 S. COUNTY ROAD 18 12555 MANCHESTER ROAD P O BOX 70100 P O BOX 869091 P O BOX 19771 P O BOX 458022 1500 S MAIN ST P O BOX 36697 P O BOX 989 P O BOX 80257 P O BOX 1984 POST OFFICE BOX 30180 P O BOX 199 P O BOX 8210 P O BOX 53235 ST. LOUIS SHREVEPORT PLANO HOUSTON WESTLAKE FT WORTH BIRMINGHAM CHESTERFIELD BATON ROUGE NASHVILLE NEW ORLEANS LYNCHBURG CLEARWATER NEW ORLEANS MO LA TX TX OH TX AL MO LA TN LA TN FL LA 63131 71137 75086 77224 44145 76104 35236 63006 70898 37202 70190 37352 34618 70153 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 45 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP JACKSON LONG AND ASSOCIATES JAMES BENEFITS - GREYHOUND CLAIMS JAMES BENEFITS-SIDA/SWA BENEFIT TRUST FUND JARDINE GROUP SERVICES JEFF DAVIS HOSPITAL EMPLOYEE BENEFITS JEFFERSON LIFE INSURANCE COMPANY 1136-00 0978-00 0781-00 2995-00 0962-00 2083-00 OLYMPIA FIELDS TEMPE ATLANTA SCHUNECTADY NATCHEZ DALLAS IL AZ GA NY MS TX 60461 85282 30303 12301 39120 75243 JEFFERSON NATIONAL LIFE INS. CO. 0239-00 INDIANAPOLIS IN 46204 JEFFERSON PARISH SHERIFF OFFICE JEFFERSON PILOT JEFFERSON PILOT JEFFERSON PILOT INSURANCE CO JEFFERSON SERVICE CO. INC JELD-WEN HEALTH BENEFIT PLAN JELDWEN JENMAR INDUSTRIES JIMMY SWAGGART MINISTRIES (SELF-INSURED) JOBMATE LEASED EMPLOYEES TRUST JOHN ALDEN LIFE INSURANCE COMPANY JOHN DEERE DEALER GROUP INS CO JOHN DEERE LIFE INS. CO. JOHN E. CHANCE & ASSOCIATES JOHN HANCOCK MUTUAL LIFE INS. CO. JOHN HANDCOCK INS CO 1185-00 1151-00 1180-01 1180-00 1891-00 2721-00 3335-00 2115-00 1494-00 1102-00 0240-00 1123-00 0241-00 1690-00 0242-00 2236-00 METAIRIE GREENSBORO GREENSBORO GREENSBORO SHREVEPORT BEND REDMOND WINNSBORO BATON ROUGE RIDGELAND BOISE MOLINE JACKSONVILLE SHREVEPORT BOSTON COLUMBUS LA NC NC NC LA OR OR LA LA MS ID IL IL LA MA OH 70001 27420 27420 27420 71135 97708 97756 71295 70821 39158 83701 61265 62651 71135 02117 43085 JOHN HOPKINS HEALTH CARE JOHN LLOYD THOMPSON SERVICES JOHN MANVILLE 3154-00 3086-00 1051-00 GLEN BURNIE SCHENECTADY PORTLAND MD NY OR 21060 12301 97205 JOHN O FELKER BENEFIT SERVICES 1385-00 ST LOUIS MO 63102 JOHNSON ADMINISTRATORS JONES,HILLS & MERCER EMPLOYEE BENEFITS,INC JSL ADMINISTRATORS JUSTISS OIL COMPANY INC JV INDUSTRIAL COMPANIES K & B PRESCRIPTION PLANS K & K SPECIALTY BENEFITS INC K C I EMPLOYEE BENEFIT TRUST K-MART COMPREHENSIVE CARE KAISER FOUNDATION HEALTH PLAN 1580-00 1298-00 3234-00 1940-00 3242-00 2707-00 3236-00 2824-00 2816-00 0766-00 NEWTOWN SAVANNAH FAYETTEVILLE SHREVEPORT MONROE NEW ORLEANS FORT WAYNE SAN ANTONIO TAMPA OAKLAND PA GA NC LA LA LA IN TX FL CA 18940 31412 28302 71135 71207 70130 46801 76265 30588 94604 KAISER PERMANENTE KAISER PERMANENTE KAISER PERMANENTE HMO 3748-00 H052-40 1796-00 ATLANTA OAKLAND PORTLAND GA CA OR 31119 94604 97210 KANAWHA KANSAS CITY LIFE INS. CO. KARE CHOICE - CIRCLE K CORP - SELF INSURED 1748-00 0243-00 1437-00 20000 GOVERNORS DRIVE P O BOX 22777 235 PEACH ST NE P O BOX 2209 PO BOX 1488 9304 FOREST LANE NORTH STE 256 JEFFERSON BUILDING ONE VIRGINIA AVENUE 3300 METAIRIE ROAD P O BOX 20727 P O BOX 20727 P O BOX 21008 P O BOX 51005 P O BOX 5128 P O BOX 1747 RT 1 BOX 33 P O BOX 2550 P O BOX 213 P O BOX 1599 P O BOX 620 110 NORTH EAST STREET POST OFFICE BOX 51005 POST OFFICE BOX 111 300 EAST WILSON BRIDGE RD SUITE 255 6704 CURTIS COURT P O BOX 2209 SUITE 440 720 S WASHINGTON ST P O BOX 8895 JEFFERSON MEMORIAL STATIO P O BOX 248 P O BOX 9888 P O BOX 2857 P O BOX 51005 P O BOX 2175 K & B PLAZA LEE CIRCLE P O BOX 2338 P O BOX 590450 P O BOX 30588 REGIONAL CLAIMS P O BOX 12923 P O BOX 190849 P O BOX 12923 2701 NORTHWEST VAUGHN SUITE 300 P O BOX 2000 POST OFFICE BOX 139 400 LOCUST ST P O BOX 9122 LANCASTER KANSAS CITY DES MOINES SC MO IA 29721 64141 50306 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 46 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP KAROON AND BLACK KAST METAL EMPLOYEE BENEFIT TRUST KELLY ASSOCIATES 1347-00 0701-00 0952-00 GREENVILLE SHREVEPORT METAIRIE MS LA LA 38701 71136 70001 KELSEYCARE ADVANTAGE KEMPER GROUP KENNESAW LIFE AND ACCIDENT INS. CO. KENTUCKY CENTRAL LIFE INS. CO. KENTUCKY HOME MUTUAL LIFE INS. CO. KEPPLE AND COMPANY INC KERR-MCGEE CORPORATION KEY BENEFIT ADMINISTRATORS KEYSTONE LIFE INS. CO. KILPATRIC LIFE INS. CO. OF LA KIMBERLY-CLARK CORPORATION KINDER HOSPITAL LAFAYETTE KINKO'S KIRBY HEALTH CARE PLAN KIRKE-VAN ORSDEL KITSAP PHYSICIAN SERVICE KLAIS & COMPANY KLEIN TOOL INSURANCE CO KLLM EMPLOYEE BENEFITS PLAN KMSB (KLAMATH MEDICAL SERVICES BUREAU) KNIGHTS AND DAUGHTERS OF TABOR KNIGHTS OF COLOMBUS HEALTH & ACCIDENT DIV. KOCH SERVICES (SELF INSURED) KOHLER CO. EMPLOYEE BENEFITS INSURANCE KRISPY KREME HEALTH CARE PLAN (SELF-INSURED) KRUEGER-RINGIER-EMPLOYEE BENEFITS L M BERRY AND CO (SELF-INSURED) L T V STEEL COMPANY 3963-00 1753-00 0244-00 0245-00 0246-00 2694-00 0857-00 2619-00 0247-00 0248-00 2103-00 3941-00 2666-00 2661-00 0899-00 3102-00 3891-00 0934-00 3554-00 2849-00 0975-00 1775-00 1114-00 1923-00 1453-00 1889-00 1457-00 2004-00 HOUSTON NEW ORLEANS ATLANTA LEXINGTON LOUISVILLE PEORIA OKLAHOMA CITY INDIANAPOLIS DALLAS SHREVEPORT ATLANTA LAFAYETTE FRESNO RICHARDSON DES MOINES BREMENTON AKRON CHICAGO OXFORD KLAMATH FALLS MOUND BAYOU OMAHA WICHITA BROWNWOOD WINSTON-SALEM ITASCA DAYATON CLEVELAND TX LA GA KY KY IL OK IN TX LA GA LA CA TX IA WA OH IL MS OR MS NE KS TX NC IL OH OH 77230 70186 30357 40508 40202 61656 73125 46205 75380 71101 30359 70508 93747 75083 50309 98337 44313 60645 38655 97601 38762 68172 67201 76804 27102 60143 45401 44101 L.D.BRINKMAN & CO LA AUTO DEALERS TRUST LA CARPENTERS REGIONAL COUNSIL 2345-00 1289-00 3631-00 DALLAS BATON ROUGE METAIRIE TX LA LA 75356 70810 70002 LA CARPENTERS REGIONALL COUNCIL 3637-00 METAIRIE LA 70002 LA LA LA LA LA LA LA LA LA LA LA LA 0505-00 1192-00 2291-00 3198-00 2362-00 3689-00 0712-01 0712-00 0728-00 1188-00 1888-00 1747-00 P O BOX 1796 P O DRAWER 6611-M 4200 S I-10 SVS RD WEST SUITE 134 P O BOX 300427 P O BOX 870730 POST OFFICE BOX 7580 KINCAID TOWERS 5TH AND JEFFERSON STREETS P O BOX 1986 KERR-MCGEE CENTER P O BOX 55210 POST OFFICE BOX 809027 1818 MARSHALL STREET P O BOX 29800 204 ENERGY PKWY P O BOX 55016 P O BOX 833835 777 THIRD ST P O BOX 339 1867 W MARKET ST 7200 MC CORMICK RD P O DRAWER 1400 P O BOX 5016 P O BOX 849 P O BOX 3477 P O BOX 2256 P O BOX 1709 P O BOX 53 ONE PIERCE PLACE P O BOX 6000 EMPLOYEE BENEFIT SERVICES P O BOX 94571 P O BOX 569710 7526 PICARDY AVE 3351 SEVERN AVE STE 202 3351 SEVERN AVE SUITE 202 POST OFFICE BOX 44036 PO BOX 246 P O BOX 246 P O BOX 7765 6902 PEARL RD/STE 500 P O BOX 1449 1407 DECATUR ST 440 N FOSTER DR #105 P O BOX 80297 P O BOX 4266 P O BOX 2636 2800 VETERANS BLVD STE 160 BATON ROUGE RACELAND RACELAND METAIRIE CLEVELAND GOODLETTSVILLE NEW ORLEANS BATON ROUGE BATON ROUGE SHREVEPORT SAN ANTONIO METAIRIE LA LA LA LA OH TN LA LA LA LA TX LA 70804 70394 79394 70010 44130 37070 70116 70806 70898 71104 78299 70002 EMPLOYEES STATE GROUP/OFFICE OF GROUP BENEFITS FOURCHE LIFE INC COMPANY FOURCHE LIFE INSURANCE CO HEALTH CARE SELF INSURANCE HELPING HANDS EMPLOYEE HEALTH PLAN VPA LABOR HEALTH & WELFARE LABORERS HEALTH & WELFARE PLAN LABORERS HEALTH AND WELFARE PLAN MUNICIPAL RISK MANAGEMENT AGENCY II PEST CONTROL ASSOC GROUP INS TRUST QUINTA MOTOR INNS INC RESTAURANT ASSOCIATION LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 47 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP LA SAFETY SYSTEMS GROUP HEALTH PROGRAM LA WORKER'S COMPENSATION CORP. LA. ALLIANCE MEDICAL CORPORATION LA. CONFERENCE METHODIST CHURCH (SELF-FUNDED) LA. HOSPITAL ASSOC. EMPLOYEES BENEFIT TRUST 2539-00 2819-00 2826-00 1443-00 1359-00 NEW IBERIA BATON ROUGE SHREVEPORT SHREVEPORT JACKSON LA LA LA LA MS 70562 70898 71104 71135 39206 LA. WHOLESALE GROCER'S ASSOCIATION LA.HORSEMEN BENEVOLENT & PROTECTIVE ASSOC INC LAB CORPS LABORATORY CORPORATION OF AMERICA LABORER'S HEALTH & TRUST FUND FOR N.CALIFORNIA LABORERS HEALTH & WELFARE LABORERS INTERNATIONAL UNION OF NORTH AMERICA LABORERS NATIONAL HEALTH/WELFARE 0958-00 2670-00 2905-00 2911-00 1225-00 2986-00 1598-00 3953-00 SAN ANTONIO NEW ORLEANS BURLINGTON SCOTTSDALE SAN FRANCISCO METAIRIE WASHINGTON COLUMBIA TX LA NC AZ CA LA DC MD 78269 70119 27215 85271 94109 70002 20006 21044 LABORS LOCAL 1177 LACARE 2673-00 9999-91 BATON ROUGE BATON ROUGE LA LA 70802 70810 LACARE INTEREST PAYMENTS INT9-91 BATON ROUGE LA 70810 LAFARGE CORP. (SELF-INSURED) LAFAYETTE CARPENTERIA LOCAL 1897 HLT & WELFARE FUND 2451-00 1111-01 MINNEAPOLIS BOSSIER CITY MN LA 55440 71111 LAFAYETTE CITY PARISH LAFAYETTE CONSOLIDATED GOVERNMENT LAFAYETTE GENERAL MEDICAL CENTER 3719-00 3823-00 1084-00 LAFAYETTE LAFAYETTE LAFAYETTE LA LA LA 70502 70506 70505 LAFAYETTE LAFAYETTE LAFAYETTE LAFOURCHE LAFOURCHE 0249-00 2402-00 2009-00 2363-00 2229-00 P O BOX 14338 P O BOX 98052 3831 GILBERT DRIVE P O BOX 51005 (LHAEBT) 5220 GALAXYY P O BOX 690465 1535 GENTILLY BLVD P O BOX 8200 P O BOX 3137 1168 SUTTER ST 3340 SEVERN AVE/STE 225 905 16TH ST NW 10440 LITTLE PATUXENT PWY SUITE 700 1233 GOVERNMENT ST 10000 PERKINS ROWE BK G 4TH FLR 10000 PERKINS ROWE BK G 4TH FLOOR P O BOX 1194 315 MONROE ST SUITE B P O BOX 4017-C 705 WEST UNIVERSITY AV GROUP MEDICAL PLAN P O BOX 52009 OCS POST OFFICE BOX 7007 P O BOX 4508 P O DRAWER 2158 P O BOX 70100 LEIGHTON FACTORY LEIGHTON RD P O BOX 12170 P O BOX 90802 8927 W NATIONAL AVE 7777 HENNESSY BLVD SUITE 1004-111 POST OFFICE BOX 880 P O BOX 51102 3831 GILBERT DR 6300 MAIN ST P O BOX 11069 P O BOX 790064 POST OFFICE BOX 40913 680 CRAIG RD SUITE 200 2500 LINE AVENUE P O BOX 539508 2311 CEDAR SPRINGS P O BOX 489 LAFAYETTE LAFAYETTE LAFAYETTE SHREVEPORT THIBODAUX IN LA LA LA LA 47903 70502 70502 71137 70301 OVERLAND PARK LUBBOCK WEST ALLIS BATON ROUGE KS TX WI LA 66212 79408 53227 70808 JACKSON LAFAYETTE SHREVEPORT ZACHARY MEMPHIS SAN ANTONIO INDIANAPOLIS ST LOUIS MS LA LA LA TN TX IN MO 39205 70508 71104 70791 38111 78279 46240 63141 SHREVEPORT GRAND PRAIRIE DALLAS INDEPENDENCE LA TX TX LA 71104 75053 75201 70443 LIFE INS. CO., THE PARISH GOVERNMENT (SELF-INSURED) PARISH SCHOOL BOARD EMPLOYEE INS. FUND PARISH WATER DISTRICT #1 SUGAR CORP (SUGAR MILL-SELF INSURED) LAHOOD & ASSOCIATES INC LAKE CHARLES MEMORIAL-SELF FUNDED LAKE COUNTRY DENTAL INSURANCE PLANS LAKE PHYSICIAN HEALTH 1492-00 3378-00 2396-00 2686-00 LAMAR LIFE INS. CO. LAMB SERVICES-TONG SPECIALTY GROUP HEALTH BENEFITS LAMCORP LANE MEMORIAL HOSPITAL LANGSTON COMPANIES INC LAQUINTA INNS (SELF-INSURED) LAYMEN NATIONAL LIFE INS. CO. LDI INTEGRATED PHARMACY SERVICES 0250-00 2935-00 3005-00 2403-00 2318-00 2048-00 0251-00 3883-00 LEE NATIONAL LIFE INS. CO. OF LA LEGACY HEALTH PLAN LEGAL SECURITY INS CO LEGGETT & PLATT INC 0252-00 3248-00 0844-00 1762-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 48 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP LEGION INSURANCE COMPANY 3064-00 DALLAS TX 75251 LEGIONNARE INSURANCE TRUST 2606-00 SANTA BARBARA CA 93102 LEWER AGENCY INSURANCE LGA HEALTH INSURANCE LHC INTEREST PAYMENTS 2136-00 0765-00 INT9-93 KANSAS CITY LAFAYETTE BATON ROUGE MO LA LA 64111 70501 70809 LHCA/LBGH LIBBY OWENS FORD (SELF-INSURED) LIBERTY DENTAL PLAN LIBERTY GROUP LIBERTY HERITAGE LIFE INS. CO. LIBERTY LIFE LIBERTY LIFE ASSURANCE CO. OF BOSTON LIBERTY LIFE INS. CO. LIBERTY MUTUAL LIBERTY MUTUAL LIBERTY MUTUAL FIRE INSURANCE COMPANY LIBERTY NATIONAL LIFE INS. CO. LIFE & HEALTH INS. CO. OF AMERICA LIFE AND CASUALTY INS. CO. OF TN LIFE ASSURANCE CO. OF PA LIFE CARE MANAGEMENT SYSTEMS INC LIFE GENERAL SECURITY INS. CO. LIFE GUARD INSURANCE CO LIFE GUARD INSURANCE CO LIFE INS. CO. OF ALABAMA LIFE INS. CO. OF LA LIFE INS. CO. OF THE SOUTH 2797-00 2678-00 3801-00 1587-00 0253-00 1161-00 0254-00 0255-00 0847-00 3714-00 1756-00 0256-00 0260-00 0258-00 0257-00 1456-00 0259-00 0017-06 1706-00 0261-00 0263-00 0265-00 BATON ROUGE COLUMBUS SANTA ANA NEW ORLEANS SHREVEPORT GAINESVILLE BOSTON GREENVILLE FRESNO MONTGOMERYVILLE IRVING BIRMINGHAM PHILADELPHIA NASHVILLE CHICAGO NEW ORLEANS METAIRIE SAN JOSE SAN JOSE GADSDEN SHREVEPORT COVINGTON LA OH CA LA LA GA MA SC CA PA TX AL PA TN IL LA LA CA CA AL LA LA 70821 43218 92799 70114 71130 30503 02117 29602 93784 18936 75015 35202 19103 37250 60601 70130 70004 95150 95150 35902 71166 70433 LIFE LIFE LIFE LIFE LIFE LIFE 0266-00 0267-00 0813-00 0264-00 0268-00 1798-00 12222 MERIT DR SUITE 850 GROUP CANCER CARE INS P O BOX 1146 4534 WORNELL RD 1116 COOLIDGE BLVD 8550 UNITED PLAZA BLVD STE 800 P O BOX 3558 P O BOX 18100 P O BOX 26110 1529 NEWTON ST 6001 FINANCIAL PLAZA P O BOX 2817 175 BERKLEY STREET POST OFFICE BOX 789 PO BOX 5014 P O BOX 1052 P O BOX 152067 POST OFFICE BOX 2612 2200 WALNUT STREET AMERICAN GENERAL CENTER 222 NORTH MICHIGAN AVENUE 650 POYDRAS ST/SUITE 1900 POST OFFICE BOX 187 P O BOX 5506 P O BOX 5506 POST OFFICE BOX 349 POST OFFICE BOX 1803 ONE NORTH LAKE CORP PARK 1000 HIGHWAY 190 POST OFFICE BOX 47421 POST OFFICE BOX 27601 P O BOX 40964 P O BOX 801067 4333 EDGEWOOD RD N E 2727 ALLEN PARKWAY WORTHAM TOWER SIXTH FLOOR P O BOX 105022 P O BOX 70 345 N RIVER VIEW STE 600 P O B 2503 4810 INDUSTRIAL DRIVE P O BOX 7709 P O BOX 91060 LILLY CORPORATE CENTER DROP CODE 2018 POST OFFICE BOX 3250 POST OFFICE BOX 80469 P O BOX 614008 DALLAS RICHMOND INDIANAPOLIS DALLAS CEDAR RAPIDS HOUSTON TX VA IN TX IA TX 75247 23261 46240 75380 52499 77019 ATLANTA SHREVEPORT WICHITA GA LA KS 30348 71136 67203 TYLER NEW IBERIA BEND SEATTLE INDIANAPOLIS TX LA OK WA IN 75710 70560 97708 98111 46285 MEMPHIS LINCOLN ORLANDO TN NE FL 38103 68501 32861 INS. CO. OF THE SOUTHWEST INS. CO. OF VIRGINIA INSURANCE CO OF INDIANA INSURANCE CO OF NORTH AMERICA INVESTORS INS. CO. OF AMERICA OF AMERICA INSURANCE CO LIFE OF GEORGIA LIFE SHAREBLOOD CENTERS LIFE STYLE HEALTH PLANS 0262-00 3328-00 3949-00 LIFELINE UNDERWRITERS LIFE INS. CO. LIFERE INSURANCE COMPANY LIFEWISE HEALTH PLAN OF OREGON LIFEWISE HEALTH PLAN OF WASHINGTON LILLY HEALTH PLAN 2543-00 2639-00 3298-00 3829-00 2714-00 LINCOLN AMERICAN LIFE INS. CO. LINCOLN BENEFIT LIFE CO. LINCOLN FINANCIAL GROUP 0269-00 0270-00 3806-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 49 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN 1915-00 3722-00 0271-00 0273-00 0274-00 1605-00 P O BOX 51005 P O BOX 10843 4808 NORTH 22ND STREET POST OFFICE BOX 81209 1300 SOUTH CLINTON STREET BENEFITS PLAN P O BOX 1210 POST OFFICE BOX 1173 2000 SPRINGER DRIVE STATE MUTUAL COMPANIES 1100 W 31 ST/STE 460 5220 AIRLINE DR 15414 KATY FREEWAY SUITE 800 P O BOX 3968 206 BEAUMONT DR P O BOX 5543 8111 TOM DR 535 ASHBY ST SW P O BOX 115027 2501 BELL AVEUNE 461 STATE RTE 33 2041 BEAUMONT DR P O BOX 1002 CHOCTAW DR 3200 RIDGE LAKE DR SUITE 207 PO BOX 52738 2061 BEAUMONT DRIVE 2706 S CLAIBORNE AVE 3449 HOLLENBERG SUITE 150 1407 DECATUR STREET 1715 COMMON STREET P O BOX 1688 P O BOX 551 P O BOX 2847 234 NORTH CENTRAL AVENUE STE. 646 POST OFFICE BOX 35047 P O BOX 7011 P O BOX 57924 P O BOX 52927 P O BOX 74170 PO BOX 2002 LOUISIANA TOWER 333 TRAVIS PO BOX 14697 P O BOX 5279 P O BOX 65133 P O BOX 610 PH # 812-289-1636 SHREVEPORT CLEARWATER PHOENIX LINCOLN FORT WAYNE BREAUX BRIDGE LA FL AZ NE IN LA 71135 33757 85016 68501 46801 70557 LOUISVILLE LOMBARD DOWNERS GROVE KY IL IL 40203 60148 60515 BOSSIER CITY HOUSTON LA TX 71111 77094 BOCA RATON BATON ROUGE ALEXANDRIA BATON ROUGE ATLANTA FL LA LA LA GA 33427 70806 71307 70808 30301 DES MOINES MANALAPAN BATON ROUGE PRAIRIEVILLE BATON ROUGE METAIRIE IA NJ LA LA LA LA 50321 07726 70806 70769 70815 70072 BATON ROUGE BATON ROUGE NEW ORLEANS BRIDGETON NEW ORLEANS LAKE CHARLES PASCAGOULA BURBANK TULSA PHOENIX LA LA LA MD LA LA MS CA OK AZ 70805 70806 70125 63044 70116 70601 39568 91520 74101 85004 DALLAS WYOMISSING LOS ANGELES LAFAYETTE BATON ROUGE ALEXANDRIA SHREVEPORT TX PA CA LA LA LA LA 75235 19610 90057 70505 70874 71309 71101 BATON ROUGE SHREVEPORT BATON ROUGE JEFFERSONVILLE LA LA LA IN 70898 71135 70896 47130 GENERAL HOSPITAL EMPLOYEE BENEFIT TRUST HERITAGE LIFE INC CO HERITAGE LIFE INS. CO. LIFE AND CASUALTY CO. NATIONAL LIFE INS CO., THE PARISH BOARD EMPLOYEES GROUP HEALTH LINCOLN-INCOME LIFE INS. CO. LINE CONSTRUCTION BENEFIT TRUST LITTLE CAESAR INERNATIONAL INC 0272-00 1996-00 1505-00 LITTLE JOE'S WELDING INC(SELF-INSURED) LIVING CENTERS OF AMERICA 1442-00 2932-00 LLOYDS UNDERWRITERS, LONDON LOCAL #317 LOCAL #576 HEALTH AND WELFARE FUND LOCAL #995 HEALTH & WELFARE FUND LOCAL NO. 218 HEALTH & WELFARE FUND 2298-00 1997-00 1562-00 1650-00 1659-00 LOCAL LOCAL LOCAL LOCAL LOCAL LOCAL 3667-00 3258-00 2007-00 1420-00 0721-00 1981-00 THIRTY THREE FUND TWENTY FIVE UNION NO 37 102 1098 FRINGE BENEFITS 130 LOCAL 198 HEALTH AND WELFARE FUND LOCAL 21 HEALTH & WELFARE FUND LOCAL 3000 LOCAL 513 HEALTH AND WELFARE FUND LOCAL 689 (LABORS UNION) LOCAL 861 HEALTH AND WELFARE FUND LOCKARD & WILLIAMS CO LOCKHEED MEDICAL PLAN LOFFLAND HEALTH COVERAGE PLAN LOMAS FINANCIAL SECURITY INS. CO. 0856-00 1956-00 2230-00 1013-00 0967-00 1944-00 3205-00 1098-00 1906-00 0275-00 LONE STAR LIFE INS. CO. LOOMIS COMPANY (SELF-INSURED) LOS ANGELES HOTEL-RESTAURANT WELFARE FUND LOSS MANAGEMENT INC LOUISIANA AIRCRAFT INC LOUISIANA ASSESSOR'S INSURANCE FUND LOUISIANA BANK AND TRUST (SELF-INSURED) 0276-00 1967-00 1488-00 1682-00 2108-00 0985-00 1222-00 LOUISIANA LOUISIANA LOUISIANA LOUISIANA 0910-00 1064-00 1520-00 1319-00 BUILDING MATERIALS DEALERS ASSOC. CO-OP PLANS INC DENTAL PLAN INC DOCK CO. LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 50 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP LOUISIANA LOUISIANA LOUISIANA LOUISIANA LOUISIANA LOUISIANA LOUISIANA ELECTRICAL HEALTH & WELFARE PLAN ELECTRICAL HEALTH FUND EMPLOYERS SAFETY ASSOCIATION GROUP ADMINISTRATORS INS HEALTH COOPERATIVE HEALTH SERVICE & INDEMNITY CO HEALTHCARE CONNECTION 1530-00 3588-00 2494-00 1026-00 3995-00 1732-00 9999-93 ALEXANDRIA GOODLETTSVILLE BATON ROUGE LAFAYETTE FOXBORO BATON ROUGE BATON ROUGE LA TN LA LA MA LA LA 71301 37070 70898 70503 02035 70804 70809 LOUISIANA LOUISIANA LOUISIANA LOUISIANA LOUISIANA LOUISIANA LOUISIANA LOUISIANA HOSPITAL ASSOCIATION BENEFIT TRUST HOUSING COUNCIL EMPLOYEE BENEFIT PLAN INDEMNITY COMPANY LABORERS HEALTH LABORERS HEALTH & WELFARE PLAN L692 MACHINERY CO INC NATIONAL LIFE INS. CO. ORGAN PROCUREMENT AGENCY 1369-00 1438-00 2092-00 3653-00 1283-00 1991-00 0277-00 2926-00 P O BOX 5543 P O BOX 1449 P O BOX 80793 1116 COOLIDGE P O BOX 9108 P O BOX 15699 8550 UNITED PLAZA BLVD STE 800 5220 GALAXIE P O BOX 1349 P O BOX 5382 P O BOX 1449 2726 WOODDALE BLVD P O BOX 51005 830 STATE STREET 3501 N CAUSEWAY BLVD SUITE 940 P O BOX 80793 1175 NICHOLSON DR P O BOX 27107 P O BOX 111 P O BOX 30010 P O BOX 5418 POST OFFICE BOX 5075 P O BOX 182223 P O BOX 849 13515 BARRET PKWY #265 PT COUPEE LUMBER-SELF INS P O BOX 5756 P O BOX 5075 P O BOX 15258 P O BOX 69309 625 4TH AVE SOUTH P O BOX 666 P O BOX 2390 820 HOWARD AVENUE P O BOX 70100 1720 KALISTE SALOOM STE C 7 4 TAFT COURT 2506 LAKELAND DR/STE 307 820 HOWARD AVE 440 LOUISIANA ST/STE 1600 25800 N. WESTERN HIGHWAY 19609 WIED RD 19609 WIED RD 1337 HUNDRED OAKS DR P O BOX 42842 P O BOX 1099 P O BOX 2034 P O BOX 14586 JACKSON HENDERSONVILLE BOSSIER CITY GOODLETTSVILLE BATON ROUGE SHREVEPORT NEW ORLEANS METAIRIE MS TN LA TN LA LA LA LA 39206 37075 71111 37070 70805 71135 70118 70002 BATON ROUGE BATON ROUGE ALBUQUERQUE NORTH WILKESBORO AUSTIN CINCINNATI SOUTHFIELD CHATANOOGA LUFKIN BALLWIN SHREVEPORT LA LA NM NC TX OH MI TN TX MO LA 70898 70802 87125 28656 78755 45201 48037 37422 75902 63021 71135 INDIANAPOLIS BATON ROUGE HARRISBURG MINNEAPOLIS BROWNSBURG TAMPA NEW ORLEANS SHREVEPORT LAFAYETTE IN LA PA MN IN FL LA LA LA 46268 70895 17106 55415 46112 33601 70113 71137 70508 ROCKVILLE JACKSON NEW ORLEANS HOUSTON SOUTHFIELD SPRING SPRING CHARLOTTE HOUSTON MAYLAND HEIGHTS MARYLANE HEIGHTS LEXINGTON MD MS LA TX MI TX TX NC TX MO MO KY 20850 39208 70113 77002 48076 77388 77388 28217 77242 63043 63043 40512 LOUISIANA RETAILER ASSOCIATION LOUISIANA SHERIFFS ASSOCIATION LOVE LAACE HEALTH INSURANCE LOWE'S COMPANIES INC,HEALTH BENEFITS LOYAL AMERICAN LIFE INS CO LOYAL AMERICAN LIFE INS. CO. LOYALTY LIFE INS. CO. LSU FIRST LUFKIN INDUSTRIES (SELF-INSURED) LUHR BROS INC HEALTH BENEFIT PLAN LUMBER INVESTOR'S INC 1964-00 1726-00 1903-00 1279-00 3747-00 0278-00 0279-00 3550-00 1948-00 3184-00 1427-00 LUMBERMAN'S LIFE INSURANCE COMPANY LUMBERMAN'S MUTUAL CASUALTY COMPANY LUMENOS LUTHERAN BROTHERHOOD LUTHERAN PREFERRED LYKES BROTHERS STEAMSHIP CO. LYMAN AGENCY INC M & L INDUSTRIES INC M A PATOUT AND SONS SELF ASSURED 1337-00 0990-00 3166-00 1528-00 3094-00 2410-00 2271-00 2563-00 2964-00 M.D. IPA HEALTH PLAN M.S. CARRIERS HEALTHCARE PLAN M.W.L. INC M-I DRILLING FLUIDS MACCABEES MUTUAL LIFE INS. CO., THE MACORI ADMINISTRATION MACORI BENEFITS MADISON BENEFIT ADMINISTRATOR MAGCOBAR-IMCO (M-I) DRILLING FLUIDS CO. MAGELLAN MAGELLAN MAGELLAN 1912-00 2930-00 2045-00 2704-00 0282-00 3124-00 3818-00 1674-00 1942-00 3519-00 3525-00 3524-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 51 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP MAGELLAN MAGELLAN BEHAVIORAL HEALTH MAGELLAN HEALTH SERVICES MAGELLAN/HMO 3526-00 3521-00 9999-96 3527-00 MARYLAND HEIGHTS MARYLAND HEIGHTS AVON MARYLAND HEIGHTS MO MO CT MO 63043 63403 06001 63043 MAGICAIRE (SELF-INSURED) 2492-00 JACKSON MS 39213 MAGNA CARE 3179-00 GARDEN CITY NY 11530 MAGNOLIA LIFE INS. CO. 0283-00 LAKE CHARLES LA 70601 MAGNOLIA MANAGEMENT CORP MAHONEY BENEFITS ADMINISTRATION MAIL HANDLERS BENEFITS PLAN MAIL HANDLERS INC. MAISON BLANCHE; INC MAJOR GROUP CLAIMS MAKSIN MANAGEMENT CORPORATION MALTA LIFE INS. CO. MAMSI LIFE & HEALTH INS CO MANAGE MED MANAGED BENEFIT PLANS INC MANAGED CARE ADMINISTRATION INC MANAGED CARE OF AMERICA (MCA) MANAGED HEALTH CARE INC 2028-00 3115-00 3514-00 0512-00 1758-00 2405-00 2303-00 0284-00 3091-00 2915-00 3215-00 1692-00 3357-00 2049-00 OPELOUSAS FT LAUDERDALE LONDON JACKSONVILLE BATON ROUGE NASHVILLE DALLAS JACKSON FREDERICK GREENVILLE HACKETTSTOWN TULSA PITTSBURGH HOUSTON LA FL KY FL LA TN TX MS MD SC NJ OK PA TX 70570 33338 40742 32231 70821 37230 75240 39216 21705 29606 07840 74135 15220 77027 MANAGED PRESCRIPTION SERVICES MANAGEMENT SERVICES INC MANHANDLERS BENEFIT PLAN MANUFACTURERS LIFE INS. CO., THE 2898-00 1866-00 1931-00 0285-00 GREEN BAY CHAMPAIGN ROCKVILLE ONTARIO WI IL MD ON 54344 61820 20850 00000 MAPCO PETROLEUM INC. CASHIER HEALTH PLAN MAPFRE LIFE INSURANCE CO MARATHON OIL COMPANY GROUP INSURANCE MARCO GROUP HEALTH PLAN MARINE CORPS ASSN HEALTH PLAN 1671-00 3725-00 1627-00 1634-00 1018-00 TULSA SAN JUAN LAFAYETTE TULSA WASHINGTON OK PR LA OK DC 74121 00936 70566 74121 20006 MARINE ENGINEERS BENEFICIAL ASSOCIATION MARINE SYSTEMS INC MARITIME ASSOCIATION I.L.A.WELFARE FUND MARK TWAIN LIFE INS. CORP. MARKEL INSURANCE CO MARKHAM GRAY AND DENNIS INC MARQUETTE NATIONAL LIFE INS CO MARQUETTE NATIONAL LIFE INS. CO. MARRIOT CORP MULTI-MED HEALTH CARE PLAN MARSH & MCLENNAN MARSH ADVANTAGE AMERICA MARSH AFFINITY GROUP MARSH AFFINITY GROUP 2367-00 2174-00 1149-00 0286-00 3089-00 2481-00 H735-70 0287-00 0811-00 1371-00 3147-00 3596-00 3595-00 P O BOX 1959 P O BOX 1118 55 NOD RD P O BOX 1119 ATTN: AUSHC 6508 DOGWOOD VIEW PKWY SUITE A 825 E GATE BLVD 2ND FLOOR SEVENTH FLOOR MAGNOLIA LIFE BLDG. 160 DUCHARME RD P O BOX 7260 P O BOX 8402 P O BOX 44242 P O BOX 91102 P O BOX 305181 14160 DALLAS PARKWAY #120 POST OFFICE BOX 55409 P O BOX 932 P O BOX 17264 P O BOX 744 4100 E 51 ST 1100 820 PARISH ST 550 POST OAK BLVD STE 400 1100 EMPLOYER BLVD 115 NORTH NEIL SUITE 409 P O BOX 6222 200 BLOOR STREET, EAST TORONTO 5 P O BOX 21628 P O BOX 70297 P O BOX 53266 P O BOX 21628 1729 H STREET NW SUITE 100 1007 EASTERN AVE P O BOX 239 11550 FUQUA SUITE 425 POST OFFICE BOX 18497 4600 COX RD P O BOX 6159 P O BOX 391883 4800 NORTH KENNETH AVENUE P O BOX 930 1579 E 21 ST. P O BOX 1520 P O BOX 10439 SENIOR MEDICAL INSURANCE P O BOX 10439 BALTIMORE SCHRIEVER HOUSTON OKLAHOMA CITY GLEN ALLEN KINSTON CAMBRIDGE CHICAGO HORSHAM TULSA IOWA CITY DES MOINES DES MOINES MD LA TX OK VA NC MA IL PA OK IA IA IA 21202 70395 77034 73154 23060 28501 02139 60630 19044 74114 52244 50306 50306 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 52 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP MARTCO EBT MARTIN HOMES CENTER INC MARYLAND CASUALTY COMPANY MASKIN MANAGEMENT CORP 3369-00 0916-00 2105-00 3633-00 ALEXANDRIA ALEXANDRIA BATON ROUGE CAMDEN LA LA LA NJ 71303 71016 70898 08103 MASS MARKET TRUST MASSACHUSETTS CASUALTY INS. CO. MASSACHUSETTS GENERAL LIFE INS. CO. MASSACHUSETTS INDEMNITY AND LIFE INS. CO. MASSACHUSETTS MUTUAL MASSACHUSETTS MUTUAL LIFE INS. CO. MASTER MATES & PILOTS MATTHEWS TRUCKING COMPANY 1635-00 0288-00 0289-00 0290-00 3350-00 0291-00 1819-00 1268-00 PHOENIX BOSTON ENGLEWOOD ATLANTA LOS ANGELES AUSTIN LINTHICUM HEIGHTS SHREVEPORT AZ MA CO GA AZ TX MD LA 85069 02109 80111 30359 90060 78714 21090 71137 MAXICARE 0767-01 LOS ANGELES CA 90015 MAXICARE OF LOUISIANA 0767-00 NEW ORLEANS LA 70112 MAXICARE OF NORTH TEXAS 1162-00 IRVING TX 75039 MAXON ADMINISTRATORS,INC. - NAT'L COUNCIL 1219-00 IRVINGTON NY 10533 MAXOR PLUS MAYFLOWER NATIONAL LIFE INS. CO. MCA ADMINISTRATORS MCCREW CARE CENTRAL MCCRORY'S STORE (EMPLOYEE BENEFITS) MCDERMOTT COMPREHENSIVE MEDICAL PLAN 3331-00 0292-00 3314-00 3264-00 2035-00 1070-00 AMARILLO LAFAYETTE PITTSBURGH COLUMBIA YORK LOS ANGELES TX IN PA SC PA CA 79101 47904 15220 29260 17402 90030 MCDONALD'S HAMBURGERS 1653-00 BATON ROUGE LA 70806 MCDONALDS INSURANCE PROGRAM MCDONOUGH CAPERTON INS CO MCELROY METAL INC MCGOLDRICK OIL CO MCGRIFF,SEIBELS AND WILLIAMS,INC MCKEE FOODS CORPORATION MCKENZIE TANK LINES (SELF-INSURED) MCKESSON CORPORATION 3601-00 1343-00 1849-00 2167-00 1497-00 2965-00 2214-00 2160-00 COLUMBIA CHARLSTON SHREVEPORT SHREVEPORT BATON ROUGE COLLEGEDALE TALLAHASSEE PORTLAND SC WV LA LA LA TN FL OR 29260 25332 71163 71129 70821 37315 32302 97205 MCNA INSURANCE COMPANY 9999-97 FORT LAUDERDALE FL 33309 MCNEESE STUDENT INSURANCE MD PHYSICIAN OF SOUTHWEST MDX HAWAII 2542-00 1885-00 3858-00 DALLAS LAKE CHARLES HONOLULU TX LA HI 75380 70602 96813 MED FIRST HEALTH PLANS 2773-00 METAIRIE LA 70002 MED PLUS THRU NATIONAL INSURANCE SERVICES MED STAR INSURANCE COMPANY MED-CERT 1075-00 2029-00 1490-00 P O BOX 1110 P O DRAWER 1110 P O BOX 14560 TWO AQUARIUM DR STE 200 P O BOX 39119 50 CONGRESS STREET 7887 E BELLEVIEW AVE POST OFFICE BOX 29500 P O BOX 60007 P O BOX 149160 5700 HAMMONDSFERRY RD SELF INSURED P O BOX 78134 1149 S BROADWAY ST STE 910 1515 POYDRAS ST SUITE 1130 122 W JOHN CARPENTER FRWY SUITE 200 OF CITIZENS,INC. 76 NORTH BROADWAY 320 SOUTHPOLK ST 401 EARL AVENUE 820 PARISH ST P O BOX 6702 2955 E MARKET ST P BOX 30654 TERMINAL ANNEX MCBR MANAGEMENT CO 7077 SOUTH CHOCTAW P O BOX 6702 P O BOX 3262 P O BOX 1148 8808 MCGOLDRICK DR P O BOX 2550 P O BOX 2078 P O BOX 1176 720 SW WASHINGTON ST 4TH FLOOR 200 W CYPRESS CREEK RD STE 500 P O BOX 809025 P O BOX 1832 500 ALA MONANA BLVD STE 2-200 3500 N CAUSEWAY BLVD SUITE 520 P O BOX 30324 400 FIELD DRIVE POST OFFICE BOX 26028 TAMPA LAKE FOREST GREENSBORO FL IL NC 33630 60045 27420 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 53 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP MED-COMP USA-INC MED-PAY INC MED-TAC MEDBEN MEDCO MEDCO MEDCO DRUGS (GENERAL MOTORS HEALTH CARE PROG) 1670-00 1729-00 2208-00 3404-00 3573-00 3646-00 2518-00 METAIRIE SPRINGFIELD NATICK NEWARK ATLANTA LEXINGTON FAIR LAWN LA MO MA OH GA KY NJ 70004 65808 01760 43058 30374 40512 07400 MEDCO HEALTH MEDCO HEALTH SERVICES MEDCORP SOUTHWEST INC MEDCOST BENEFIT SERVICES LLC MEDCOST PREFERRED MEDI-PLUS MEDICA INSURANCE CO MEDICAL ADMINISTRATORS MEDICAL BENEFIT PLAN MEDICAL BENEFITS ADMINISTRATORS MEDICAL BENEFITS ADMINISTRATORS MEDICAL CONTROL INC MEDICAL COST MANAGEMENT MEDICAL INSURANCE ADMINISTRATORS MEDICAL MUTUAL OF OHIO MEDICAL PLANS INC MEDICAL PLANS OF LOUISIANA INC MEDICAL SEVICES CORPORATION MEDICAL TRUST ADMINISTRATORS MEDICLAIM MEDICO INSURANCE COMPANY MEDICO LIFE INS. CO. MEDIMET MEDIMPACT 3645-00 3354-00 2646-00 3989-00 3249-00 0944-00 3197-00 1581-00 2582-00 3788-00 3570-00 2711-00 2936-00 0836-00 2957-00 0860-00 0777-00 1724-00 1863-00 2809-00 3932-00 0293-00 2288-00 3394-00 HARRISBURG DALLAS AUSTIN WINSTON SALEM WINSTON SALEM DES MOINES SAN ANTONIO MONTICELLO SAN ANTONIO DUBUQUE FOREST HILL DALLAS METAIRIE POMPANO BEACH CLEVELAND JACKSON METAIRIE ATLANTA CLARION DANVILLE DES MOINES OMAHA UTICA SAN DIEGO PA TX TX NC NC IA TX NY TX IA MD TX LA FL OH MS LA GA IA IL IA NE NY CA 17106 75265 78766 27114 27114 50309 78265 12701 78217 52004 21050 75220 70009 33061 44101 39216 70009 30339 50525 61834 50306 68105 13504 92131 MEDIMPACT 3421-00 SAN DIEGO CA 92131 MEDIPLAN MEDISHARE MEDPAY EXPRESS LLC MEGA LIFE MEGA LIFE AND HEALTH INSURANCE MEGELLAN MEGELLAN 2063-00 3436-00 3464-00 2026-00 3560-00 3522-00 3520-00 FAIRLAWN STERLING LAKE CHARLES IRVING NORTH RICHLAND HILLS MARYLAND HEIGHTS MARYLAND HEIGHTS NJ IL LA TX TX MO MO 07410 61081 70602 75015 76182 63043 63043 MEGELLAN CLAIMS MEGELLAN/PPO MEISEL PHOTOCHROME (SELF-INSURED) 3528-00 3523-00 1950-00 MAR GREENSBORO ADDISON MO NC TX 63043 27402 75001 MELDRUM BUSINESS SYSTEMS MEMBER SERVICE ADMINISTRATOR MEMORIAL HEALTH NETWORK 2631-00 2021-00 2546-00 P O BOX 788 P O BOX 10909 4 CHRYSLER ROAD P O BOX 1099 P O BOX 740800 P O BOX 14711 P O BOX 6121 11900 TOLLITT DR P O BOX 69316 P O BOX 650322 P O BOX 9201 P O BOX 25987 P O BOX 25307 777 THIRD ST P O BOX 659752 217 BROADWAY P O BOX 171720 P O BOX 389 P O BOX 950 9649 WEBB CHAPEL RD P O BOX 6794 PO BOX 619001 P O BOX 6018 PO BOX 5364 P O BOX 6215 1995 NORTHPARK PLACE #290 P O BOX 540 P O BOX 4007 P O BOX 10386 3860 LEAVENWORTH STREET P O BOX 3018 10680 TREENA ST 5TH FLR 10680 TREENA ST 5TH FL. P O BOX 590 P O BOX 674 P O BOX 2108 P O BOX 152152 P O BOX 982009 P O BOX 1189 ATTN: BLUE LINKS P O BOX 1568 P O BOX 1655 P O BOX 26106 GENELCO INCORPORATED P O BOX 915 P O BOX 70010 P O BOX 3028 9494 SOUTHWEST FREEWAY SUITE 300 SHREVEPORT TULSA HOUSTON LA OK TX 71137 74102 77074 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 54 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP MEMORIAL HERMAN BAPTIST MENNONITE MUTUAL AID ASSOCIATION 3501-00 1484-00 HOUSTON GOSHEN TX IN 77274 46526 MENTAL HEALTH NETWORK MERCER ADMINISTRATION MERCER ADMINISTRATION 3223-00 3311-00 3427-00 AUSTIN IOWA CITY ST LOUIS TX IA MO 78720 52244 63101 MERCHANT'S DUTCH EXPRESS INC MERCK MEDCO RX OF TEXAS (MMRX) MERCY BAPTIST/SELECT HEALTH 1925-00 2878-00 2731-00 SHREVEPORT DALLAS NEW ORLEANS LA TX LA 71135 75265 70115 MERCY CARE MERCY CARE ADVANTAGE MERCY HEALTH PLANS MERCY 50 + HEALTH CARE MERIDIAN BENEFITS INC MERIT INDUSTRIES (SELF-INSURED) MERIT LIFE INS. CO. MERITAGE EMPLOYER SERVICES 3900-00 H558-00 3384-00 1603-00 3117-00 1975-00 0294-00 3134-00 PHOENIX PHOENIX SPRINGFIELD NEW ORLEANS WAYNE BATON ROUGE EVANSVILLE RENO AZ AZ MO LA NJ LA IN NV 85072 85072 65808 70119 07470 70879 47708 89501 MERITAIN HEALTH MERITAIN HEALTH MERITAIN HEALTH MERITAIN HEALTH MERITAIN HEALTH MERITAIN INSURANCE MERVYN'S HEALTH PLAN TRUST MESA LTD PARTNERSHIP MEDICAL BENEFIT PLAN 3321-00 3458-00 3696-00 3692-00 3643-00 3329-00 1221-00 1404-00 AMHERST MINNEAPOLIS SHREVEPORT RICHARDSON LUBBOCK AMHERST SAN JOSE AMARILLO NY MN LA TX TX NY CA TX 14226 55427 71137 75088 79493 14226 95150 79801 MET LIFE DENTAL METALCRAFTERS UNITED AUTO WORKERS LOCAL 449 METHODIST CARE 3581-00 1651-00 3127-00 LEXINGTON PEORIA HOUSTON KY IL TX 40512 61614 77046 METLIFE DENTAL METLIFE INSURANCE COMPANY OF CT METLIFE LTC GROUP METLIFE NETWORK (SHELL HSM PLAN) METRA HEALTH METRA HEALTH PLANS METRIC CONSTRUCTORS 3657-00 3626-00 3853-00 1803-00 2775-00 2696-00 2211-00 EL PASO OMAHA LEXINGTON AUSTIN DALLAS SALT LAKE CITY CHARLOTTE TX NE KY TX TX UT NC 79998 68175 40512 78744 75265 84130 28210 METRO AMBULANCE METROPLUS HEALTH PLAN METROPOLITAN 2375-00 H042-30 0295-06 MONROE BIRMINGHAM DALLAS LA AL TX 71211 35238 75266 METROPOLITAN GROUP HEALTH 0295-04 UTICA NY 13501 METROPOLITAN INS. METROPOLITAN INSURANCE METROPOLITAN INSURANCE 1089-00 0295-05 0295-07 P O BOX 742567 1110 NORTH MAIN ST P O BOX 483 P O BOX 209010 P O BOX 4542 701 MARKET ST SUITE 1350 P O BOX 51005 P O BOX 650322 4500 MAGNOLIA ST SUITE 400 P O BOX 52089 P O BOX 52089 P O BOX 4568 301 N JEFFERSON DAVIS PKW P O BOX 311700 P O BOX 74330 601 N.W. SECOND STREET 300 EAST SECOND ST 15TH FLOOR P O BOX 9501 P O BOX 27267 P O BOX 2886 P O BOX 853921 P O BOX 94488 P O BOX 765 P O BOX 50011 1 MESA SQUARE P O BOX 2009 P O BOX 14093 612 WEST GLEN AVE TWO GREENWAY PLAZA SUITE 500 P O BOX 981282 3316 FARNAM ST P O BOX 14407 1701 DIRECTORS BLVD P O BOX 650403 P O BOX 30998 TWO SOUTH EXECUTIVE PARK 6135 PARK ROAD P O BOX 4825 P O BOX 381508 P O BOX 66051 12902 E 51ST ST ZIP:74134 CLAIMS KODAK UNIT 501 BLEEKER ST 500 SCHOOL HOUSE ROAD P O BOX 2925 GROUP CLAIMS DEPT 1130 N CASE PARKWAY JOHNSTOWN ENGLEWOOD MARIETTA PA CO GA 15904 80150 30067 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 55 TPL CARRIER FILE LISTING CARRIER NAME METROPOLITAN LIF METROPOLITAN LIFE GROUP CLAIMS METROPOLITAN LIFE INS CO METROPOLITAN LIFE INS. CO. MGIC LIFE INS. CORP. MGIS COMPANIES MHA DIVERSIFIES SERVICES INC MHC EMPLOYEE BENEFIT TRUST MHC EMPLOYEE BENEFITS TRUST MHEALTH - CHEVRON CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP 0295-03 1031-00 0295-02 0295-00 0280-00 1804-00 2172-00 3919-00 1612-00 3930-00 500 SCHOOL HOUSE RD PO BOX 7202 P O BOX 470 P O BOX 2072 222 NORTH DEARBORN STREET 600 N PARK P O BOX 16707 P O BOX 1110 P O BOX 1110 7737 SOUTH WEST FREEWAY STE C97 P O BOX 48098 3044 WEST GRAND BLVD. 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PAUL MONROE SAN ANTONIO OXFORD JACKSON JACKSON GULFPORT GULFPORT WI GA TX MS MN UT MN LA TX MS MS MS MS MS 54650 30559 76101 39567 55416 84130 55101 71211 78217 38655 39236 39206 39501 39503 MHF INSURANCE ADMINISTRATORS INC MIC LIFE INS. CORP. MICACARE MICHIGAN EDUCATION SPECIAL SERVICES MICHIGAN HEALTH INSURANCE CO MID AMERICA ASSURANCE CO OF LA MID AMERICA MUTUAL LIFE MID SOUTH MEDICAL BENEFIT PLAN MID-AMERICA LUMBERMENS ASSOCIATION MID-AMERICA NATIONAL MID-ATLANTIC BENEFIT ADMINISTRATORS MID-CONTINENT LIFE INS. CO. MID-SOUTH INSURANCE CO. MID-SOUTH LIFE INS. CO. MID-WEST NATIONAL LIFE INS CO MID-WEST NATIONAL LIFE INS. CO. OF TN MID-WESTERN LIFE INS CO MIDDLE ATLANTIC LIFE INS CO MIDLAND ENTERPRISE HEALTH CARE PLAN MIDLAND NATIONAL LIFE INS. CO. MIDSOUTH NATIONAL BANK MIDWEST BENEFITS MIDWEST EMPLOYEE LEASING INC MIDWEST NATIONAL LIFE MIDWEST OPERATING ENGINEERS WELFARE FUND 3165-00 0281-00 3471-00 2751-00 3272-00 0296-00 2152-00 1414-00 2447-00 0999-00 1425-00 0297-00 1231-00 0299-00 1519-00 0301-00 0300-00 1661-00 1745-00 0298-00 2290-00 1145-00 2235-00 3615-00 1295-00 MIDWEST SECURITY ADMINISTRATORS MILICO INSURANCE CO MILLERS LIFE INS. CO. OF TX, THE MILLETTE ENTERPRISES, INC MINISTERS LIFE - A MUTUAL LIFE INS. CO. MINNESOTA COMPREHENSIVE HEALTH ASSO MINNESOTA MUTUAL LIFE INS. CO., THE MISCO INC (SELF INSURED COMPANY) MISSION PETROLEUM CARRIERS/MEDICAL BENEFIT PLAN MISSISSIPPI ADMINISTRATIVE SERVICE MISSISSIPPI CARPENTER BENEFITS PLAN MISSISSIPPI HOSP EMPLOYEE BENEFIT TRUST INS MISSISSIPPI POWER COMPANY MEDICAL BENEFIT PLAN MISSISSIPPI SELECT HEALTH CARE 3499-00 1314-00 0302-00 1579-00 0303-00 3640-00 0304-00 1126-00 2588-00 2496-00 1802-00 1217-00 1331-00 3031-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 56 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP MISSOURI NATIONAL LIFE INS. CO. MISSOURI PACIFIC EMPLOYEES' HEALTH ASSOCIATION MISSOURI PACIFIC R R CO MMM HEALTHCARE MO KAN TEAMSTERS 0305-00 1376-00 0762-00 H400-30 2685-00 KANSAS CITY ST LOUIS ST LOUIS SAN JUAN KANSAS CITY MO MO MS PR MO 64112 63150 63103 00936 64111 MOBIL BENEFITS SERVICE CENTER MODERN AMERICAN LIFE INS. CO. MOLINA HEALTHCARE INC MOLINA HEALTHCARE OF MICHIGAN MONARCH LIFE INS. CO. MONTGOMERY WARD LIFE INS. CO. 3082-00 0306-00 3440-00 H592-60 0307-00 0308-00 SECAUCUS SPRINGFIELD LONG BEACH TROY SPRINGFIELD SCHAUMBURG NJ MO CA MI MA IL 07096 65801 90801 48084 01133 60194 MONUMENT BUILDERS OF NORTH AMERICA MONUMENTAL GENERAL INS. CO. MONUMENTAL LIFE INSURANCE CO MONY FINANCIAL SERVICES GROUP CHAINS 1768-00 0309-00 0310-00 0922-00 EVANSTON BALTIMORE SCRANTON DALLAS IL MD PA TX 60201 21202 18504 75231 MOODY PRICE EMPLOYEE BENEFIT TRUST MOREHOUSE GEN HOSP MEDICAL BENEFITS PLAN 2299-00 0946-00 BATON ROUGE BASTROP LA LA 70805 71220 MORGAN GROUP RESOURCE MORGAN-WHITE ADMINISTRATORS, INC MORRIS & DICKSON CO., LTD. MORRIS ASSOCIATES MORRIS MANAGEMENT INCORPORATED MORTON INTERNATIONAL GROUP BENEFIT MORTON-THIOKOL MOTEL 6 MOTIVATION EDUCATION AND TRAINING INC MOTOROLA MOUNTAIN CLAIMS MGMT MOUNTAIN STATES ADMINISTRATION 3605-00 3336-00 2508-00 3218-00 0992-00 1554-00 0803-00 2046-00 2361-00 2240-00 3620-00 2547-00 DULUTH JACKSON SHREVEPORT NEW PORT RICHEY COLUMBIA NEW IBERIA MARSHALL DALLAS CLEVELAND PHOENIX FRUITLAND AURORA GA MS LA FL LA LA TX TX TX AR IN CO 30096 39236 77135 34656 71418 70562 75670 75240 77328 85038 83619 80014 MS ADMINISTRATIVE SERVICES MSH INTERNATIONAL MULHEARN PROTECTIVE INSURANCE CO MULTI PLAN NETWORK MULTIPLAN INC MULTIPLE BUSINESS BENEFIT FUND MURPHY OIL CO USA INC MURPHY'S LEASE & WELDING SERV 2368-00 3945-00 1764-00 2855-00 3831-00 1028-00 2333-00 0827-00 OXFORD BEEBE PLAIN MONROE OXFORD DEPERE BIRMINGHAM ELDORADO ABBEYVILLE MS VT LA MS WI AL AR LA 38655 05823 71210 38655 54115 35205 71730 70510 MURRAY ENVELOPE CORP 2094-00 HATTIESBURG MS 39404 MUTUAL MUTUAL MUTUAL MUTUAL MUTUAL MUTUAL 1933-00 0311-00 1060-00 2027-00 0312-00 1324-00 4646 ROANOKE PARKWAY P O BOX 500352 201 N 13TH ST RM 1001 P O BOX 71305 3100 BROADWAY SUITE 400 P O BOX 1569 POST OFFICE BOX 7007 P O BOX 22668 100 W BIG BEAVER/STE 600 1250 STATE STREET MONTGOMERY WARD INS TOWER 200 N. MARTINGALE ROAD 1612 CENTRAL ST MUNSEY BUILDING P O BOX 97 SUITE 280 LOCK BOX #4 8144 WALNUT HILL LANE 2966 LUPINE AVE MOREHOUSE GEN HOSPITAL PO BOX 1060 P O BOX 100043 P O BOX 16708 P O BOX 51367 P O BOX 5001 P O BOX 1209 P O BOX 1496 P O BOX 1149 P O BOX 809092 P O BOX 1749 P O BOX 209005 P O BOX 1008 2530 SOUTH PARKER RD #606 P O BOX 1400 P O BOX 77 207 TALEMAQUE P O DRAWER 1400 P O BOX 5007 P O BOX 3326-A 200 PEACH ST HEALTH & WELFARE TRUST 1828 S HENRY STREET GROUP INSURANCE PLAN P O BOX 15789 P O BOX 42096 520 BROAD STREET P O BOX 15699 P O BOX 2976 1740 BROADWAY P O BOX 14 OKLAHOMA CITY NEWARK BATON ROUGE MILWAUKEE NEW YORK HOUSTON OK NJ LA WI NY TX 73123 07101 70895 53201 10019 77001 ASSURANCE ADMINISTRATORS BENEFIT LIFE INS. CO., THE EMPLOYEE'S TRUST #2 GROUP LIFE INS. CO. OF NY, THE LIFE INSURANCE LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 57 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP MUTUAL MUTUAL MUTUAL MUTUAL 2745-00 1833-00 0743-00 0526-00 220 EMERSON PLACE P O BOX 6963 MUTUAL OF OMAHA PLAZA 505 N. ERVAY ST. POST OFFICE BOX 3189 P O BOX 6097 P O BOX 3368 P O BOX 3477 1515 S 75TH STREET POST OFFICE BOX 2222 3000 EAST U.S. 30 BY-PASS P O BOX 64035 P O BOX 2207 1313 L STREET NW P O BOX 62107 P O BOX 2710 HEALTH & WELFARE PLAN 10054 I-10 SERV RD,BLDG 1 2715 MACKEY OFFICE PL #207 P O BOX 9709 10877 WATSON ROAD P O BOX 189 700 EAST OGDEN AVE STE 203 2646 S LOOP WEST/STE 280 2135 WISCONSIN AVE LITHCOTE ROAD P O BOX 982009 1421 PRINCE ST/STE 320 P O BOX 2009 85 WEST ALGONQUIN RD 5TH FLOOR P O BOX 925426 P O BOX 12190 1750 HENNETIN AVENUE 7887 E BELLEVIEW AVE 1599 LITTLETON ROAD 7130 COLUMBIA GATEWAY SUITE A C/O TAYLOR CARROWAY AGCY P O BOX 1459 P O BOX 612067 CONSOLIATED ADMINISTRATOR S.INC P O BOX 37429 100 INDIANA AVE 20547 WAVERLY COURT 410 WEST FLAGLER ST 15333 JFK BLVD/STE 505 8000 CORPORATE DRIVE P O BOX 3970 DAVENPORT LINCOLN OMAHA DALLAS IA NE NE TX 52801 68506 68175 75221 ROCKVILLE OMAHA OMAHA MD NE NE 20850 68103 68103 DECATUR FORT WAYNE ST PAUL SCHENECTADY WASHINGTON HOUSTON NEW TOWN NEW ORLEANS AL IN MN NY DC TX PA LA 35601 46805 55164 12301 20005 77205 18940 70127 SHREVEPORT LA 71118 NEW IBERIA ST. LOUIS BRIDGTON WESTMONT LA MO MA IL 70562 63127 04009 60559 HOUSTON WASHINGTON VILLEPLATTE NORTH RICHLAND HILLS ALEXANDRIA NATCHITOCHES ARLINGTON HEIGHTS TX DC LA TX VA LA IL 77054 20007 70586 76182 22314 71457 60005 HOUSTON ALEXANDRIA MINNEAPOLIS ENGLEWOOD PARSIPPANY COLUMBIA TX LA MN CO NJ MD 77292 71315 55403 80111 07054 21046 BILOXI MS 39533 DALLAS RALEIGH TX NC 75261 27627 WASHINGTON ASHBURN MIAMI HOUSTON LANDOVER LAFAYETTE DC VA FL TX MD LA 20001 20149 33134 77032 20785 70502 MEDICAL OF NEW YORK REMEMBER GRP HOSP PLAN OF OMAHA OF OMAHA INS. CO. SOUTHWEST DIVISION MUTUAL OF OMAHA, POSTAL SUPERVISOR'S HEALTH PLAN MUTUAL PLAN ADMINISTRATORS INC MUTUAL PROTECTIVE INSURANCE CO 1483-00 2312-00 0917-00 MUTUAL SAVINGS LIFE INS. CO. MUTUAL SECURITY LIFE INS. CO. MUTUAL SERVICE LIFE INS CO. MVP HEALTHCARE N A G E HEALTH BENEFIT PLAN N.L. INDUSTRIES (SELF-INSURED) N.L.J. ADMINISTRATORS N.O GLASSWORKERS & PICTORIAL PAINTERS LOCAL #936 0313-00 0314-00 1879-00 H961-50 1296-00 1527-00 2315-00 2246-00 N.W. LA. CARPENTER'S HEALTH & WELFARE FUND 2406-00 NABORS LOFFLAND DRILLING CO. NAEDA GROUP INSURANCE TRUST NAHGA CLAIMS SERVICES NAPA GROUP INSURANCE SERVICES 2421-00 1820-00 3684-00 1412-00 NAPP NARFE INSURANCE ADM NARMON HOLDINGS INSURANCE COMPANY NASA NAT'L ELECTRICAL CONTRACTORS ASSOC GROUP INS.TRUST NATCHITOCHES PARISH HOSPITAL NATIONAL ACCIDENT INSURANCE UNDERWRITERS INC 2519-00 0774-00 1061-00 2620-00 2599-00 0723-00 2338-00 NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL 2981-00 2376-00 1561-00 0317-00 0318-00 3817-00 ADMINISTATORS AFFILIATED INVESTORS LIFE INS CO AMERICAN LIFE AND CASUALTY COMPANY AMERICAN LIFE INS. CO. AMERICAN LIFE INS. CO. OF PA ASBESTOS WORKERS MEDICAL NATIONAL ASSOC. BUSINESS TRUST 1480-00 NATIONAL ASSOCIATION FOR THE SELF EMPLOYED NATIONAL ASSOCIATION OF HOME BUILDERS 1780-00 1947-00 NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL 0524-00 0948-00 1071-00 2702-00 1852-00 1029-00 ASSOCIATION OF LETTER CARRIERS ASSOCIATION OF LETTER CARRIERS ASSOCIATION OF MUSIC MERCHANTS(NAMM) ASSOCIATION OF PREFERRED PROVIDERS AUTOMATIC SPRINKLER INDUSTRY WELFARE FUND BENEFIT ADMINISTRATION LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 58 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP NATIONAL BENEFIT LIFE INS. CO. NATIONAL BENEFITS CORPORATION 0319-00 1458-00 NEW YORK HORSHAM NY PA 10016 19044 NATIONAL BUSINESS ACCT TRUST 1475-00 LOUISVILLE KY 40202 NATIONAL BUSINESS ASSOCIATION TRUST NATIONAL CARE NETWORK 1536-00 3796-00 BILOXI IRVING MS TX 39533 75039 NATIONAL CASUALTY COMPANY NATIONAL CATHOLIC SCHOOL INSURANCE 0840-00 1265-00 ST LOUIS STILLWATER MO MN 63108 55082 NATIONAL CINEMA SERVICE CORPORATION NATIONAL CLAIM ADMINISTRATORS INC NATIONAL COUNCIL OF ALLIED EMPLOYEES-LOCAL 55 2956-00 1552-00 2179-00 KANSAS CITY WILLISTON ENCINO MO NY CA 64141 11596 91436 NATIONAL DENTAL PLANS INC NATIONAL ELEVATOR INDUSTRY HEALTH BENEFIT CO NATIONAL ELEVATOR INDUSTRY HLTH BEN 2379-00 2507-00 3785-00 BATON ROUGE NEWTOWN SQUARE NEWTOWN SQUARE LA PA PA 70879 19073 19073 NATIONAL EMPLOYEE BENEFIT ADMINISTRATORS NATIONAL EMPLOYEE BENEFIT SERVICES INC NATIONAL EMPLOYEE BENEFIT TRUST 0833-00 1813-00 1113-00 HOUSTON SCARBOROUGH ATLANTA TX ME GA 77043 04074 30340 NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL 1053-00 2089-00 1448-00 0320-00 1411-00 TWO PARK AVENUE 110 GIBRALTER RD SUITE 116 HEYBURN BUILDING/7TH FL 332 WEST BROADWAY P O BOX 1459 222 WEST LAS COLINAS BLVD SUITE 1500 4242 LINDELL BLVD SCHOOL INSURANCE ONLY P O BOX 82 BOX 41029 11 HILLSIDE AVE HEALTH & WELFARE PLAN 16133 VENTURA BLVD P O BOX 77210 P O BOX 477 19 CAMPUS BLVD SUITE 200 10810 OLD KATY ROAD P O BOX 1239 3855 PRESIDENTIAL PARKWAY N E P O BOX 1280 13530 INWOOD RD P O BOX 6333 POST OFFICE BOX 2986 777 MAIN ST SUITE 900 777 MAIN STREET CONTINENTAL PLAZA P O BOX 619075 666 FIFTH AVENUE P O BOX 619999 9110 EAST NICHOLLS AVE STE 320 300 GALLERIA PARKWAY SUITE 650, P O BOX 723049 POST OFFICE BOX 33888 LIBERTY PARK ADMINISTRATION OFFICES NORTHEAST LA.ALUMNI ASSN. 8330 MOBERLY LANE P O BOX 30324 P O BOXX 64035 POST OFFICE BOX 3668 P O BOX 37502 150 ALLENDALE ROAD AMERICAN GENERAL CENTER NATIONAL LIFE DRIVE P O BOX 52616 NASHVILLE DALLAS ROCKVILLE OVERLAND PARK FORTHWORK TN TX MD KS TX 37202 75244 70850 66201 76102 FORT WORTH TX 76102 DALLAS NEW YORK DFW AIRPORT ENGLEWOOD TX NY TX CO 75261 10103 75261 80112 ATLANTA GA 30339 SHREVEPORT FRAZER VALLEY FORGE DALLAS LA PA PA TX 71130 19355 19494 75227 TAMPA ST PAUL LITTLE ROCK OAK PARK VALLEY FORGE NASHVILLE MONTPELIER NEW ORLEANS FL MN AR MI PA TN VT LA 33630 55164 72203 48237 19481 37250 05602 70152 EMPLOYERS TRUST FAMILY CARE LIFE INSURANCE CO FEDERATION OF FEDERAL EMPLOYEES FIDELITY LIFE INS. CO. FINANCIAL INSURANCE CO NATIONAL FOUNDATION LIFE INS. CO. 0321-00 NATIONAL NATIONAL NATIONAL NATIONAL 1938-00 0323-00 0322-00 2145-00 GROUP LIFE HEALTH & WELFARE LIFE INS. ASSN., INC. HEALTH INS. CO. HEALTH SYSTEMS INC NATIONAL HEALTHCARE INC 2011-00 NATIONAL NATIONAL NATIONAL NATIONAL HERITAGE EMPLOYEE BENEFIT TRUST HOME LIFE ASSURANCE CO. HOME LIFE ASSURANCE COMPANY INSURANCE ADMINISTRATORS 1572-00 0324-00 0829-00 1097-00 NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL INSURANCE SERVICES,INC INSURANCE TRUST INVESTORS LIFE INS. CO. LABOR UNION LIBERTY LIFE INS. CO. LIFE & ACCIDENT INS. CO., THE LIFE INS. CO. LINEN SERVICE 1230-00 1152-00 0325-00 1524-00 0326-00 0327-00 0328-00 2082-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 59 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL MARITIME UNION MARKETING & ADMINISTRATION MEDICAL ENTERPRISES MEDICAL HEALTH CARD SYS. MOTOR CLUB LIFE & ACCIDENT INS. CO. OLD LINE INS. CO. PACIFIC DENTAL 1320-00 3143-00 1275-00 3417-00 0329-00 0330-00 3238-00 NEW YORK HOUSTON LOS ANGELES PORT WASHINGTON DALLAS LITTLE ROCK HOUSTON NY TX CA NY TX AR TX 10003 77272 90025 11050 75201 72203 77008 NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL NATIONAL RELIGIOUS BRAODCASTERS (SELF-INSURED) REPUBLIC LIFE INS. CO. RESERVE LIFE INS. CO. RISK MANAGEMENT/OWNERS CHOICE ROOFERS UNION ROOFERS UNION RURAL ELECTRIC COOPERATIVE ASSOC RX SAVINGS LIFE INS. CO. SECURITY LIFE & ACCIDENT INS CO SENIOR CITIZENS GROUP INSURANCE TRUST 1502-00 0331-00 0332-00 2286-00 3259-00 3230-00 1834-00 2456-00 0333-00 1297-00 0463-01 404 LAFAYETTE STREET P O BOX 721900 11620 WILSHIRE BLVD P O BOX 1170 2711 CEDAR SPRINGS POST OFFICE BOX 2900 1445 NORTH LOOP WEST STE 500 2001 MARCUS AVE POST OFFICE BOX 33999 BOX 1279 1204 LAKE SHORE DR P O BOX 21240 P O BOX 21240 P O BOX 6249 P O BOX 612 POST OFFICE BOX 1338 P O BOX 15279 NATIONAL EXECUTIVE OFFICE 4850 STREET RD BOX 7158 STATION C P O BOX 179 P O BOX 719 1712 MAGNAVOX WAY P O BOX 2338 POST OFFICE BOX 27321 ATT BENEFITS P O BOX 23528 P O BOX 802207 NORTHWESTERN PLAZA SUITE 1010 P O BOX 55284 70 PINE STREET HEALTH WELFARE FUND 7370 CHEF MENTEUR HWY P O BOX 4504 112 SOUTH 16TH ST P O BOX 421169 13650 NW 8TH ST CENTERPOINT 3 SUITE 172 600 SIX FLAGS DR ONE NATIONWIDE PLAZA P O BOX 420 9301 SOUTHWEST FREEWAY STE. 475 P O BOX 5367 P O BOX 999 P O BOX 10136 P O BOX 22625 P O BOX 162145 LAKE SUCCESS SHREVEPORT TOPEKA LAKE CHARLES DENVER DENVER LINCOLN FAIRLAWN MURFREESBORO ARLINGTON TREVOSE NY LA KS LA CO CO NE NJ TN TX PA 11042 71130 66601 70601 80221 80221 68506 07410 37130 76015 19049 ATLANTA GA 30357 HARVEY HARVEY FORT WAYNE LA LA IN 70059 70059 46801 ST. LOUIS HARAHAN MO LA 63141 70183 DALLAS ASHEVILLE TX NC 75380 28801 METAIRIE NEW YORK NEW ORLEANS LA NY LA 70055 10270 70126 SHREVEPORT PHILADELPHIA HOUSTON SUNRISE ARLINGTON LA PA TX FL TX 71134 19102 77742 33325 76011 COLUMBUS SPRINGFIELD HOUSTON OH MA TX 43216 01101 77074 ROCKFORD APPLETON FAIRFAX JACKSON ALTAMONTE SPRINGS IL WI VA MS FL 61125 54912 22030 39255 32716 NATIONAL SERVICE INDUSTRIES INC 2466-00 NATIONAL SOCIETY OF HEALTH NATIONAL SOCIETY OF HEALTH NATIONAL SPORTS UNDERWRITERS 1364-00 1354-00 2397-00 NATIONAL STATES INS. CO. NATIONAL TEA CO HEALTH & WELFARE PLAN 0334-00 2509-00 NATIONAL TEACHERS ASSOCIATES LIFE INSURANCE CO NATIONAL TELEPHONE COOPERATIVE ASSOCIATION 2968-00 1216-00 NATIONAL TRESHOLD PLAN NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONAL UNION OF OPERATORS & ENGINEERS 1730-00 0819-00 1422-00 NATIONAL WASHINGTON INS NATIONAL-BEN FRANKLIN CO.-VWWI HEALTH INS PLANS NATIONALWAY HEALTHCARE ASSOCIATION NATIONS HEALTH NATIONWIDE GROUP INSURANCE 1867-00 2537-00 3269-00 3217-00 1341-00 NATIONWIDE LIFE INS. CO. NATIONWIDE LIFE INSURANCE COMPANY NAVAJO LIFE INS. CO. 0335-00 3470-00 0336-00 NAVISTAR AETNA BENEFITS NAVITUS HEALTH SOLUTIONS NCAS (NATIONAL CAPITAL ADMINISTRATIVE SERVICES) NEEL SCHAFFER INC NEESE INDUSTRIES INC 1140-00 3944-00 2548-00 2782-00 1721-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 60 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP NEIGHBORHOOD HEALTH PARTNERSHIP NESTLE USA GROUP BENEFIT PLANS NETWORK DENTAL PLAN 2984-00 2499-00 2681-00 MIAMI GLENDALE DALLAS FL CA TX 33102 92109 75240 NETWORK MANAGEMENT INC NEVADA CARE NEW ENGLAND CARE HEALTH PLAN NEW ENGLAND GENERAL LIFE INS. CO. NEW ENGLAND INSURANCE CO 1133-00 3356-00 2618-00 0337-00 2016-00 MERCER ISLAND LAS VEGAS DALLAS BOSTON ATLANTA WA NV TX MA GA 98040 89137 75231 02117 30346 NEW ENGLAND LIFE 1372-00 TAMPA FL 33630 NEW NEW NEW NEW NEW ENGLAND MUTUAL LIFE INS. CO., THE ERA LIFE INS COMPANY JERSEY LIFE INS. CO. ORLEANS CHOICE PLAN ORLEANS ELECTRICAL HEALTH & WELFARE PLAN 0338-00 1955-00 0339-00 2749-00 0783-00 BOSTON HOUSTON SADDLE BROOK KENNER METAIRIE MA TX NJ LA LA 02117 77210 07662 70065 70002 NEW ORLEANS EMPLOYERS NEW ORLEANS ROOFING & WELFARE PLAN LOCAL 141 NEW ORLEANS SHEET METAL WORKERS 3717-00 1676-00 0887-00 NEW ORLEANS NEW ORLEANS METAIRIE LA LA LA 70130 70116 70002 NEW NEW NEW NEW NEW NEW NEW 1232-00 1531-00 0805-00 3090-00 1334-00 0340-00 1859-00 P O BOX 025680 P O BOX 29059 14800 LANDMARK BLVD SUITE 700 P O BOX 1220 P O BOX 379020 1000 N CENTRAL EXPRESSWAY 501 BOYLSTON STREET 115 PERIMETER CENTER SUITE 465 WEST CLAIMS DEPARTMENT P O BO 501 BOYLSTON STREET P O BOX 4884 PARK 80 PLAZA WEST 200 WEST ESPLANADE #606 3200 RIDGE LAKE SUITE 123 147 CARONDELET ST/STE 300 1407 DECATUR STREET HEALTH AND WELFARE FUND 4400 YALE STREET 2450 SEVERN AVE #517 P O BOX 2469 P O BOX 42576 2624 N 5TH ST P O BOX 60577 1 MUTUAL OF OMAHA PLAZA 195 BROADWAY SUITE 8BE P O BOX 51772 8183 W ELK CALJON P O BOX 802422 5301 AUGUST AVE 6928 SAINTS AVE 10877 WATSON RD P O BOX 2310 P O BOX 420 SPRINGFIELD P O BOX 5087 3510 LINCOLN WAY P O BOX 1149 346 W17TH ST POST OFFICE BOX 1447 P O BOX 2291 P O BOX 2291 P O BOX 70100 PO BOX 12170 P O BOX 21734 1833 PLANTSIDE DR 4417 CORPORATION LANE METAIRIE TUSCALOOSA SAN FRANCISCO MILES NEW ORLEANS OMAHA NEW YORK LA AL CA MI LA NE NY 70001 35403 94142 49120 70160 68175 10007 LAFAYETTE BATON ROUGE DALLAS MARRERO METAIRIE ST LOUIS MOUNT CLEMENS LA LA TX LA LA MO MI MA 70501 70815 75380 70072 70003 83127 48046 01101 THIBODAUX AMES PERU NEW YORK CEDAR RAPIDS MORGAN CITY MORGAN CITY SHREVEPORT OVERLAND PARK SHREVEPORT LOUISVILLE VIRGINIA BEACH LA IA IN NY IA LA LA LA KS LA KY VA 70302 50014 46970 10011 52406 70381 70380 71137 66212 71151 40299 23462 ORLEANS STEAMSHIP ASSOCIATION SOUTHLAND NATIONAL INSURANCE CO SYSTEMS INC WORLD CLAIMS SERVICES YORK LIFE & CHAMBER-NEW ORLEANS GRP CLAIMS OFFICE YORK LIFE INS. CO., THE YORK STATE EMPLOYER BENEFITS PROGRAM NEWPARK RESOURCES INC NEWTRON GROUP INC NEXCALIBER NEXION HEALTH CARE NFI PLAYERS GROUP INS. PLAN NFPEDA GROUP INSURANCE TRUST NGS CORESOURCE NHP SPECIALTY HEALTH CLAIMS 0761-00 2758-00 3137-00 3243-00 2742-00 0750-00 3878-00 3591-00 NICHOLS STATE INSURANCE NIPPON LIFE INSURANCE CO. OF AMERICA NIXON NEWSPAPER'S INC NMU PENSION TRUST NN INVESTORS LIFE INS. CO., INC. NOBLE INSURANCE CO NOBLE LOWNDES/JOHNSON/SEACOR MARINE INC. NOE ENTERPRISES, INC NOMDA GROUP INS. TRUST NORAM BENEFITS NORMAL LIFE INC NORSHIP CO - POS-M/C 2530-00 2835-00 2558-00 0778-00 0315-00 2034-00 2059-00 2777-00 0905-00 2630-00 2322-00 2778-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 61 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP NORTH NORTH NORTH NORTH NORTH NORTH NORTH NORTH NORTH NORTH NORTH 2668-00 2372-00 0342-00 1792-00 2033-00 0341-00 2974-00 2409-00 1057-00 0344-00 0343-00 P O BOX 1984 P O BOX 1984 1015 E. BROAD STREET 10877 WATSON ROAD P O BOX 94928 POST OFFICE BOX 466 P O BOX 9501 150 EAST GILMAN STREET P O BOX 32127 1750 HENNEPIN AVENUE STE. 104 57 RIVER STREET P O BOX 44160 P O BOX 30025 411 W. 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PAUL LUBBOCK IRVING SPRINGHILL WINSTON-SALEM NORTHBROOK DENVER ST CLAIR SHORES SEATTLE DALLAS SEATTLE THIBODEAUX BATON ROUGE MILWAUKEE MINNEAPOLIS NORCROSS DES MOINES GRAND ISLAND LITTLE ROCK CAROL STREAM LINCOLN MN TX TX LA NC IL CO MI WA TX WA LA LA WI MN GA IA NY AR IL NE 55164 79408 75016 71075 27116 60062 80221 48080 98111 75244 98102 70301 70821 53202 55440 30093 50309 14072 72221 60197 68506 ALEXANDRIA DALLAS ASHVILLE VA TX NC 22314 75240 28801 WASHINGTON HOLDEN DC LA 20065 70744 CHICAGO IL 60602 AUSTIN BEDFORD TX TX 78701 76021 TULSA OK 74102 AMERICA ADMINISTRATION AMERICA ADMINISTRATORS AMERICA EQUITABLE LIFE ASSUR. CO. AMERICAN BENEFIT ADMINISTRATORS AMERICAN BENEFITS NETWORK AMERICAN CO. FOR LIFE AND HEALTH INS. AMERICAN HEALTH PLANS AMERICAN INS COMPANY AMERICAN INS TRUST(AMERICAN HLT NETWORK INC) AMERICAN LIFE AND CASUALTY CO. AMERICAN LIFE ASSURANCE CO. NORTH AMERICAN SUPPLEMENT INS NORTH CAROLINA COMPREHENSIVE STATE HEALTH PLAN NORTH CAROLINA MUTUAL LIFE INS. CO. 3879-00 1858-00 0346-00 NORTH CENTRAL LIFE INS. CO. NORTH OAKS HEALTH SYSTEM NORTH TEXAS HEALTH CARE NORTH WEBSTER MEDICAL SERVICE NORTHBROOK INS CO NORTHBROOK LIFE INS. CO. NORTHERN COLORADO ROOFERS HEALTH AND WELFARE NORTHERN GROUP SERVICES INC NORTHERN LIFE INS. CO. NORTHROP HEALTH CARE PLAN NORTHWEST ADMINISTRATORS INC NORTHWESTERN LIFE INSURANCE NORTHWESTERN MUTUAL LIFE INS. NORTHWESTERN MUTUAL LIFE INS. CO., THE NORTHWESTERN NATIONAL LIFE INS. CO. NORTHWESTERN NATIONAL LIFE OF GA NORWEST FINANCIAL INC NOVA HEALTH CARE ADMINISTRATORS NOVA SYSTEM HEALTH NRA CANCER CARE NRECA (NATIONAL RURAL ELECTRIC COOPERATION ASSOC) 0347-00 3284-00 2677-00 1952-00 1056-00 0345-00 2139-00 0884-00 0348-00 0998-00 1679-00 1569-00 1911-00 0349-00 0350-00 2478-00 2129-00 2597-00 3966-00 2857-00 0753-00 NRLCA ASSOCIATE HOSPITAL PLAN NTA LIFE INS. CO. NTCA 1201-00 0316-00 3697-00 NTEU NUMANCO L.L.C. 2119-00 2971-00 NWNL GROUP 1550-00 NYLACOR OAK TREE ADMINISTATORS INC 2836-00 1795-00 OCCIDENTAL COMPREHENSIVE MEDICAL PLAN 1235-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 62 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP OCCIDENTAL HEALTH INS. CO. OF NEW ORLEANS 0517-00 NEW ORLEANS LA 70112 OCCIDENTAL LIFE INS. CO. OF NC 0351-00 RALEIGH NC 27605 OCHSNER HEALTH PLAN ODS HEALTH PLAN OFF SHORE LOGISTICS (AIR LOGISTICS) OFFICE DEPOT HEALTH PLAN OFFICE OF GROUP BENEFITS OHIO CASUALTY INSURANCE CO. OHIO NATIONAL LIFE ASSURANCE CORP. OHIO NATIONAL LIFE INS. CO., THE OHIO STATE LIFE INS. CO., THE OHMSTEDE INC OKLAHOMA NATIONAL LIFE INS. CO. 0841-00 3240-00 1409-00 2776-00 3531-00 1585-00 0352-00 0353-00 0354-00 2116-00 0355-00 LEXINGTON PORTLAND LAFAYETTE LITTLE ROCK BATON ROUGE HAMILTON CINCINNATI CINCINNATI COLUMBUS JACKSON IRVING KY OR LA AR LA OH OH OH OH MN TX 40512 97208 70505 72203 70804 45012 45201 45201 43216 56143 75062 OLD AMERICAN INS. CO. OLD DOMINION FREIGHT LINE,INC. OLD REPUBLIC LIFE INS. CO. OLD SOUTHERN LIFE INS. CO. OLD SURETY LIFE INSURANCE CO OLIN DIRECT CLAIMS SERVICE (SELF-INSURED) OLOL REGIONAL MEDICAL CENTER (SELF-INSURED) OLYMPIC HEALTH MANAGEMENT SYSTEMS INC OMAHA FINANICAL LIFE INS. CO. OMEGA SERVICE OMNI CARE HEALTH PLAN OMNI GROUP OMNI-TRUST ONE CARE BY CARE FIRST ARIZONA 0356-00 2747-00 0357-00 0358-00 2017-00 1166-00 2552-00 2933-00 0359-00 2281-00 2087-00 1901-00 1928-00 H543-00 KANSAS CITY WINSTON SALEM CHICAGO MONTGOMERY OKLAHOMA CITY STRATFORD BATON ROUGE BELLINGHAM ST. 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SUITE 2000 POST OFFICE BOX 10234 CAMERON VILLAGE P O BOX 14601 P O BOX 4030 P O BOX 53178 P O BOX 8074 P O BOX 44036 136 NORTH THIRD ST POST OFFICE BOX 237 POST OFFICE BOX 237 POST OFFICE BOX 910 146 INDUSTRIAL PARK 4545 FULLER DRIVE STE. 230 3520 BROADWAY P O BOX 25307 307 N. MICHIGAN AVENUE POST OFFICE DRAWER 911 P O BOX 54407 150 LONG BEACH BLVD 7777 HENNESSEY BLVD P O BOX 5348 POST OFFICE BOX 1711 P O BOX 14338 7650 SECOND AVE P O BOX 66635 DRAWER T-393 2355 E CAMELBACK ROAD STE 300 P O BOX 11111 P O BOX 934 1720 KALISTE SALOOM RD SUITE C7 DIVERSIFIED CONSULTANTS P O BOX 792128 P O BOX 1208 P O BOX 7067 P O BOX 5028 4 TERRY ROAD SUITE 1 P O BOX 30758 2400 WEST BAY DRIVE P O BOX 40384 ADMINISTRATION BLDG STE.201 LAKEFRONT AIRPORT PARKER PLEAS BROWN/DAVIS P O BOX 30176 P O BOX 8097 P O BOX 690450 LONDON SAN ANTONIO KY TX 40742 78269 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 63 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP OSCAR MAYER OTIS ENGINEERING CORP. GROUP BENEFITS PROGRAM OUACHITA NATIONAL BANK OUR LADY OF LOURDES REGIONAL MEDICAL CENTER OUR LADY OF THE LAKE RMC OUTSIDE ELECTRICAL WELFARE FUND OXFORD FREEDOM PLAN OXFORD LIFE INS. CO. OXFORD MEDICARE COMPLETE OZARK NATIONAL LIFE INS. CO. P F L LIFE INSURANCE COMPANY P FIVE ELECTRONIC HEALTH SERVICES P-FIVE ELECTRIC HEALTH SERVICES PA HEAVY & HIGHWAY CONTRACTORS WELFARE PLAN PACC HEALTH PLAN PACE GREATER OF NEW ORLEANS PACIFIC CARE OF CALIFORNIA PACIFIC CARE OF TEXAS PACIFIC FIDELITY LIFE INS. CO. PACIFIC HERITAGE ASSURANCE PACIFIC MUTUAL BENEFIT PACIFIC MUTUAL BENEFITS PACIFIC MUTUAL GROUP 2255-00 1846-00 0915-00 1720-00 2643-00 2637-00 2786-00 1571-00 H310-70 0361-00 2101-00 3148-00 3380-00 2267-00 2258-00 3934-00 2100-00 2845-00 0362-00 0982-00 1829-00 0018-29 2003-00 MADISON DUNCAN MONROE LAFAYETTE BATON ROUGE HUNTINGTON NORWALK PHOENIX BRIDGEPORT KANSAS CITY LITTLE ROCK SALT LAKE CITY SALT LAKE CITY HARRISBURG CLACKAMAS CINCINNATI CYPRESS SAN ANTONIO CEDAR RAPIDS PORTLAND COVINGTON COVINGTON FORT WRIGHT WI OK LA LA LA WV CT AZ CT MO AR UT UT PA OR OH CA TX IA OR KY KY KY 53707 73534 71201 70502 70898 25729 06856 85004 06601 64016 72203 84109 84109 17112 97015 45206 90630 76265 52499 97207 41016 41016 41011 PACIFIC MUTUAL LIFE INS. CO. PACIFIC SOURCE HEALTH PLANS PACIFIC STANDARD LIFE INS. CO. PACIFICARE PACIFICARE LIFE 0363-00 2671-00 0364-00 2972-00 H543-50 NEWPORT BEACH EUGENE SACRAMENTO COLORADO SPRINGS SAN ANTONIO CA OR CA CO TX 92660 97401 95808 80935 78265 PACIFICARE OF TEXAS H459-00 SAN ANTONIO TX 78230 PAID DENTAL PAID PRESCRIPTIONS,INC PAINTERS DISTRICT COUNCIL 2569-00 1317-00 2592-00 AUSTIN FAIR LAWN WALLINGFORD TX NJ CT 78766 07410 06432 PAINTERS-PAPERHANGERS-LU1244 H & W 1916-00 ATLANTA GA 30345 PALMETTO GBA PAN AMERICAN LIFE PAN ENERGY CORP PAN-AMERICAN LIFE INS. CO. PANAMA CANAL HEALTH INS 3940-00 3865-00 2876-00 0365-00 1325-00 COLUMBUS LUBBOCK HOUSTON NEW ORLEANS APO MIAMI OH TX TX LA FL 43218 79490 77251 70160 34011 PANHANDLE EASTERN INS. CO. PARACELSUS HEALTH CARE CORP (SELF-INSURED) 0824-00 2392-00 HOUSTON PASADENA TX CA 77027 91101 PARAGON BENEFITS INC PARAMOUNT LIFE INS. CO. PARAMOUNT-SECURITY LIFE INS. CO. PARISH GOV RISK MANAGEMENT AGENCY-GROUP HEALTH 3087-00 0366-00 0367-00 0731-00 P O BOX 7188 P O BOX 6000 P O BOX 1412 611 ST LANDRY 5000 HENNESSY BLVD P O BOX 2967 P O BOX 5031 2721 NORTH CENTRAL AVE P O BOX 7082 906 GRAND AVENUE P O BOX 2900 P O BOX 9554 P O BOX 9554 P O BOX 6250 P O BOX 286 619 OAK ST P O BOX 6006 8200 IH 10 WEST POST OFFICE BOX 1447 P O BOX 1020 P O BOX 16190 P O BOX 16190 LOOKOUT CORPORATE CENTER 1717 DIXIE HWY/STE 700 700 NEWPORT CENTER DRIVE P O BOX 7068 POST OFFICE BOX 1796 P O BOX 15180 SECURE HORIZONS DIRECT P O BOX 659787 8200 IH-10 STE 1000 P O BOX 9201 1900 POLLITT DR NO 11 HEALTH FUND P O BOX 5817 2300 HENDERSON MILL RD #414 P O BOX 182932 P O BOX 99007 P O BOX 1642 POST OFFICE BOX 60219 PANAMA CANAL AREA BENEFIT GROUP INS BOARD 5005 RIVERWAY 155 N LAKE AVE SUITE 1100 P O BOX 1526 POST OFFICE BOX 710 1525 LINE AVENUE 320 SOUTH IBERIA ST DOUGLASVILLE LITTLE ROCK SHREVEPORT NEW IBERIA GA AR LA LA 30133 72203 71101 70560 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 64 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP PARISH GOVERNMENT RISK MANAGEMENT 0960-00 BATON ROUGE LA 70898 PARISH GOVERNMENT RISK MANAGEMENT PARKER DRILLING CO GROUP HEALTH 3899-00 3376-00 METAIRIE HOUSTON LA TX 70009 77077 PARTNERS HEALTH PLAN OF LOUISIANA 1752-00 METAIRIE LA 70002 PARTNERS INSURANCE CO PARTNERS NATIONAL HEALTH PLAN PARTNERSHIP HEALTH PLAN OF CA PASSPORT ADVANTAGE PAT HANEY & SON PATCO ASSURANCE CO PATIENT'S CHOICE 1254-00 1546-00 3924-00 3614-00 2204-00 2571-00 2931-00 IRVING MEMPHIS SUISUN HATTIESBURG DALLAS BOSSIER CITY BATON ROUGE TX TN CA PA TX LA LA 75015 38187 94585 17106 75236 71111 70816 PATIENT'S COMPENSATION FUND PAUL M. DAVISON PETRO PRODUCTS PAUL REVERE LIFE INS. CO., THE PAYFLEX SYSTEMS, USA PAYLESS CASHWAYS BENEFIT PLAN PBP HEALTH PLAN PCA SOLUTIONS INC PCS INCORPORATION (PHARMACEUTICAL CARD SYSTEM) PEARL REAL ESTATE TRUST PEERLESS INSURANCE COMPANY 3176-00 1037-00 0368-00 1604-00 2759-00 3195-00 2766-00 1356-00 2746-00 1009-00 BATON ROUGE RUSHTON WORCESTER OMAHA KANSAS CITY SAN ANTONIO BATON ROUGE PHOENIX PEORIA KEENE LA LA MA NE MO TX LA AZ IL NH 70821 71270 01608 68131 64141 78278 70898 85072 61614 03431 PEKIN LIFE INSURANCE COMPANY PEN WEL INC PENINSULAR LIFE INS. CO. PENN CARE PLUS PENN GENERAL SERVICES OF GA. PENN LIFE INS CO 2293-00 2500-00 0369-00 1540-00 1260-00 1332-00 PEKIN PITTSBURGH JACKSONVILLE HOUSTON ATLANTA SHAWNEE MISSION IL PA FL TX GA KS 61558 15250 32204 77282 30358 66201 PENN MUTUAL LIFE INS. CO., THE PENN TREATY NETWORK PENNINGTON ENTERPRISES INC PENNSYLVANIA EMPLOYEE BENEFIT TRUST FUND 0370-00 3706-00 2209-00 2015-00 PHILADELPHIA PENSACOLA HAMMOND HARRISBURG PA FL LA PA 19105 32591 70404 17101 PENNSYLVANIA LIFE INS. CO. PENSION & GROUP SERVICES INC PENSION ASSOCIATES INC PENSION LIFE INS. CO. OF AMERICA PENSION SERVICES IND PEOPLE HEALTH PEOPLE'S HEALTH NETWORK 0371-00 1965-00 1785-00 0372-00 1619-00 4004-00 2682-00 SANTA MONICA KALAMAZOO ST LOUIS VALLEY FORGE NEW ORLEANS METAIRIE METAIRIE CA MI MO PA LA LA LA 90406 49003 63127 19482 70116 70010 70005 PEOPLES (PROVIDIAN) BENEFIT LIFE INS. CO. 2722-00 VALLEY FORGE PA 19482 PEOPLES HEALTH 3561-00 METAIRIE LA 70002 PEOPLES HEALTH H196-10 CONCORDIA PARK PO BOX 80297 P O BOX 6794 1401 ENCLAVE PARKWAY STE 600 3838 N CAUSEWAY BLVD SUITE 1919 P O BOX 152280 P O BOX 171823 P O BOX 610 P O BOX 69325 P O BOX 670602 P O BOX 5382 3029 S SHERWOOD FOREST BL SUITE 200 P O BOX 3718 P O DRAWER 310 18 CHESTNUT STREET 200 BLACKSTONE CENTRE P O BOX 419973 P O BOX 782369 P O BOX 80297 P O BOX 52115 1200 EAST GLEN AVENUE 62 MAPLE AVENUE INSURANCE BUILDING 2505 COURT ST P O BOX 371969 645 RIVERSIDE AVENUE P O BOX 820969 P O BOX 720677 AM TRUST ADM INC P O BOX 87 530 WALNUT STREET P O BOX 130 P O BOX 819 5TH FLOOR CITY TOWERS 301 CHESTNUT STREET 3130 WILSHIRE BOULEVARD P O BOX 4022 3701 S LINDBERGH POST OFFICE BOX 807 1407 DECATUR ST P O BOX 7890 111 VETERANS BLVD SUITE 1424 CLAIMS SERVICE DIVISION P O BOX 1343 3838 N CAUSEWAY BLVD SUITE 2200 3838 N CAUSEWAY BLVD METAIRIE LA 70002 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 65 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP PEOPLES HEALTH PPO H550-10 METAIRIE LA 70002 PEOPLES LIFE INS. CO. OF S.C. PEQUOT HEALTH CARE 1695-00 3764-00 GREENVILLE MASHANTUCKET SC CT 29609 06339 PERCS PERFORMAX PERRET-DOISE, LAW FIRM -EMPLOYEE BENEFIT SRVCS PERSONAL CARE PERSONAL LIFE INSURANCE CO. PERSONNEL RISK MANAGEMENT PETROLEUM EQUIPMENT TOOLS COMPANY 2724-00 1940-60 2650-00 3650-00 0373-00 2487-00 2178-00 LOS VEGAS KING OF PRUSSIA SHREVEPORT LONDON ENID HOUSTON HOUSTON NV PA LA KY OK TX TX 89109 19406 71137 40742 73701 77060 77227 PETROLEUM GEO-SERVICES INC PHARMACARE PHARMACY ASSOCIATES PHCS PHILADELPHIA AMERICAN PHILADELPHIA AMERICAN PHILADELPHIA AMERICAN LIFE INSURANCE CO PHILLIPS ADMINISTRATIVE SERVICE INC PHILLIPS MEDICAL DENTAL PLAN PHOENIX HOME LIFE INS. PHOENIX MUTUAL LIFE INS. CO. PHP OF TENNESSEE INC PHYSICIAN ALLIANCE PHYSICIANS CORPORATION OF AMERICA (PCA) PHYSICIANS HEALTH PLAN PHYSICIANS LIABILITY INSURANCE COMPANY PHYSICIANS LIFE INSURANCE PHYSICIANS MANAGED CARE PHYSICIANS MUTUAL INSURANCE CO PHYSICIANS MUTUAL INSURANCE CO PIAS OF LOUISIANA BENEFIT TRUST PICCADILLY HEALTH INS PICKETT FOOD SERVICES INCORP PIEDMONT AMERICAN LIFE PILGRIM LIFE INS. CO. OF AMERICA PILGRIMS PRIDE CORP. (SELF-INSURED) PILOT LIFE INS. CO. PINNACLE HEALTH CLAIMS MANAGEMENT 3600-00 3277-00 2521-00 3590-00 0375-00 0374-00 0848-00 2076-00 2632-00 2534-00 0376-00 3245-00 H126-40 2657-00 1205-00 2765-00 3810-00 2948-00 3737-00 0377-00 1509-00 1500-00 1066-00 0851-00 0378-00 2505-00 0379-00 3182-00 SAN ANTONIO PITTSBURGH LITTLE ROCK NEW ORLEANS HOUSTON HOUSTON HOUSTON ALBANY ARLINGTON AGAWAM HARTFORD KNOXIVLLE BATON ROUGE SAN ANTONIO SHREVEPORT OKLAHOMA CITY OMAHA NORTHBROOK OMAHA OMAHA NASHVILLE BATON ROUGE SHREVEPORT WINSTON-SALEM KING OF PRUSSIA HUNTINGTON BEACH GREENSBORO MINDEN TX PA AR LA TX TX TX OR TX MA CT TN LA TX LA OK NE IL NE NE TN LA LA NC PA CA NC NV 78269 15230 72221 70163 77252 77252 77001 97321 76015 01001 06115 37932 70884 78265 71133 73126 68103 60062 68103 68131 37212 70816 71104 27116 19406 92647 27420 89423 PIONEER ADMINISTRATIVE SERVICES PIONEER BANK & TRUST CO PIONEER LIFE PIONEER LIFE INS. CO. OF IL PIONEER MUTUAL LIFE INS. CO. PIONEER TELEPHONE COOPERATIVE PIPEFITTER'S LOCAL UNION #195 HEALTH & WELFARE FUND PIPEFITTERS LOCAL 597 WELFARE FUND PIPELINE INDUSTRY BENEFIT FUND 3790-00 2633-00 1874-00 0380-00 0381-00 2186-00 1914-00 2197-00 1104-00 3838 CAUSEWAY BLVD STE 2200 1300 RUTHERFORD RD P O BOX 3620 BUILDING 3 2950 S INDUSTRIAL RD P O BOX 61505 P O BOX 70100 P O BOX 7141 POST OFFICE BOX 1746 411 N BELT E #330 P O BOX 27706 ATTN: INSURANCE DEPT P O BOX 690450 P O BOX 2860 P O BOX 2307 1100 POYDRAS ST/STE 2600 P O BOX 2927 P O BOX 2465 PO BOX 2465 P O BOX 218 P O BOX 91555 P O BOX 3005 ONE AMERICAN ROW 1420 CENTERPOINT BLVD P O BOX 83179 P O BOX 659515 P O BOX 37870 P O BOX 26727 P O BOX 3313 609 ACADEMY DR P O BOX 2018 2600 DODGE ST P O BOX 120539 3232 S SHERWOOD FOREST BL 3811 GILBERT AVE P O BOX 11107 550 WEST DEKALB PIKE P O BOX 3239 POST OFFICE 20727 2248 MERIDIAN BLVD SUITE B P O BOX 186 P O BOX 52868 P O BOX 619077 127-129 N WYMAN ST 203 NORTH 10TH STREET P O BOX 839 P O DRAWER C 45 N OGDEN DR P O BOX 470950 SYRACUSE SHREVEPORT DALLAS ROCKFORD FARGO KINGFISHER NEDERLAND CHICAGO TULSA NY LA TX IL ND OK TX IL OK 13206 71135 75261 61101 58102 70760 77627 60607 74147 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 66 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP PIPETRADES HEALTH AND WELFARE PLAN PIRELLI ARMSTRONG TIRE CORP PITTMAN & ASSOCIATES PIZZA HUT CLAIMS PLAINS ALL AMERICAN PLAN ADMINSTRATOR PLAN AMERICAN LIFE INSURANCE PLAN SERVICES PLANNED ADMINISTRATORS PLANNED ADMINISTRATORS INC PLANNED BENEFIT SERVICE PLATINUM SAFETY AND CLAIMS SERVICES PLAYER'S CASINO PLUM CREEK PLUMBERS & FITTERS LOCAL 514 PLUMBERS & STEAM FITTERS LOCAL #60 PLUMBERS & STEAMFITTERS PLUMBERS & STEAMFITTERS PLUMBERS & STEAMFITTERS HEALTH & WELFARE PLAN PLUMBERS & STEAMFITTERS LOCAL #760 PLUMBERS & STEAMFITTERS UNION, LOCAL 141 0769-00 3332-00 2709-00 2584-00 2998-00 1983-00 2851-00 0748-00 1491-00 3572-00 1288-00 3128-00 2732-00 2865-00 2764-00 0785-00 3755-00 2070-00 0861-00 1898-00 0901-00 TERRE HAUTE GOODLETTSVILLE MEMPHIS COLUMBIA HOUSTON RIDGELAND NEW ORLEANS TAMPA CORPUS CHRISTI COLUMBIA SCOTTSDALE TYLER LAKE CHARLES MINNEAPOLIS WARRENVILLE METAIRIE BUCKEYTOWN PINEVILLE MONROE MUSCLE SHOALS SHREVEPORT IN TN TN SC TX MS LA FL TX SC AZ TX LA MN IL LA MD LA LA AL LA 47803 37070 38111 29224 77210 39158 70130 33630 78404 29260 85252 75711 70601 55440 60555 70002 21717 71360 71203 35662 71129 PLUMBERS AND STEAMFITTERS LOCAL 106 PLYMOUTH TUBE CO.INS POLARIS BENEFIT ADMINISTRATORS POLYCHROME CORP POMCO POOL CO INS POSITIVE CARE POSTAL SUPERVISORS HEALTH BENEFIT PLAN POSTAL WORKER UNION POSTMASTERS BENEFIT PLAN PPG INDUSTRIES INC INDUSTRIAL CHEMICAL DIV PPO NEXT PPO PLUS PPO-NEXT C/O NATIONAL CARE NETWORK 0994-00 0941-00 2970-00 2605-00 2923-00 1290-00 2533-00 1660-00 3400-00 0870-00 0729-00 3365-00 3150-00 3508-00 LAKE CHARLES WEST MONROE DELAWARE GLEN COVE SYRACUSE HOUSTON SHAWNEE MISSION ROCKVILLE HARRISBURG ALEXANDRIA LAKE CHARLES DALLAS LUBBOCK IRVING LA LA OH NY NY TX KS MD PA VA LA TX TX TX 70601 71291 43015 11542 13217 77210 66207 20850 17105 22314 70601 75354 79408 75039 PRAETORIAN MUTUAL LIFE INS. CO. PRAIRIE STATES LIFE INS. CO. PRECISE BENEFITS ADMINISTRATORS PREFERRED BENEFIT ADMINISTRATORS PREFERRED CARE PREFERRED CARE INC PREFERRED CARE OF CAROLINA'S INC PREFERRED COMMUNITY CHOICE PPO PREFERRED HEALTH ALLIANCE CORP PREFERRED HEALTH CARE LIMITED 0382-00 0383-00 3173-00 3098-00 0032-71 3802-00 2117-00 2854-00 3287-00 2320-00 DALLAS RAPID CITY JERICHO LONGWOOD FT WASHINGTON FREDERICK CHARLOTTE TULSA BIRMINGHAM TAMPA TX SD NY FL PA MD NC OK AL FL 75221 57709 11753 32791 19034 21702 28220 74101 35238 33607 PREFERRED LIFE INS. CO. PREFERRED MEDICAL PROVIDERS INC PREFERRED PLAN OF GEORGIA 0384-00 2627-00 1791-00 P O BOX 3040 P O BOX 1449 P O BOX 111047 P O BOX 23759 P O BOX 4648 P O DRAWER 958 147 CARONDELET ST P O BOX 30078 3104 S ALEMEDA P O BOX 6702 P O BOX 8883 P O BOX 6367 800 BILBO ST P O BOX 1195 30W 160 CALUMET AVE 3515 I10 SERVICE RD P O BOX 845 701 MAIN ST PO BOX 4617 P O BOX 2567 HEALTH & WELFARE 7113 W BERT KOUNS IND.LP 822 N LAKESHORE 601 GRANTHAM AVE P O BOX 1008 50 GLEN ST P O BOX 6329 P O BOX 4271 P O BOX 7930 P O BOX 6093 P O BOX 069025 1019 W ROYAL ST P O BOX 1000 P O BOX 549023 P O BOX 90802 222 WEST LAS COLINAS BLVD STE 1500 MILLENIUM CTR POST OFFICE BOX 419 POST OFFICE BOX 1736 P O BOX 9064 P O BOX 916188 1300 VIRGINIA DR/STE 315 P O BOX 1325 P O BOX 11700 P O BOX 3270 P O BOX 382048 1715 NORTHWEST SHORE BLVD SUITE 775 POST OFFICE BOX 1231 P O BOX 65 P O BOX 6450 MONTGOMERY BAY ST LOUIS NORCROSS AL MS GA 36192 39520 30091 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 67 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP PREFERRED RISK LIFE INS. CO. PREMIER BANK CORPORTATION PREMIER NETWORK PREMIERE LIFE INS. CO. PREPAID HEALTH PLAN PRESBYTERIAN CHURCH PRESCRIPTION SOLUTION PRESCRIPTION SOLUTIONS PRESCRIPTION SYSTEM DELIVERY INC PRESIDENTIAL LIFE INSURANCE PRI-MED PRIMARY CARE NETWORK PRIMARY PHYSICIAN CARE PRIMARY SELECT PRIMARY SELECT PRIME THERAPEUTICS PRIMERICA PRINCIPAL PRINCIPAL FINANCIAL GROUP PRINCIPAL HEALTH CARE PRINCIPAL HEALTH CARE OF INDIANA PRINCIPAL HEALTH CARE OF LOUISIANA PRINCIPAL LIFE INSURANCE PRINCIPAL LIFE INSURANCE CO 0385-00 1738-00 2251-00 0386-00 2464-00 2644-00 3418-00 3395-00 1542-00 1864-00 0882-00 2370-00 3476-00 3016-00 0030-16 3396-00 2220-00 3515-00 1117-00 2411-00 3018-00 1517-00 3660-00 3066-00 WEST DES MOINES SHREVEPORT JACKSON SHREVEPORT BALDWINSVILLE PHILADELPHIA SAN DIEGO SAN DIEGO HATBORO DALLAS MEMPHIS LITTLE ROCK CHARLOTTE CHARLOTTESVILLE CHARLOTTESVILLE SAINT PAUL DULUTH COLORADO SPRINGS HOUSTON SAN ANTONIO INDIANAPOLIS METAIRIE COLORADO SPRINGS BATON ROUGE IA LA MN LA NY PA CA CA PA TX TN AR NC VA VA MN GA CO TX TX IN LA CO LA 50265 71135 56143 71130 13027 19101 92150 92150 19040 75228 38187 72203 28220 22902 22902 55164 30990 80949 77096 78279 46204 70011 80949 70808 PRINCIPAL MUTUAL LIFE PRINTING INDUSTRY ASSOCIATION OF THE SOUTH PRIORITY HEALTH PRIVATE AMERICAN INSURANCE COMPANY PRIVATE HEALTH CARE SYSTEMS/ALC 1127-00 2450-00 3857-00 1746-00 1854-00 DES MOINES NASHVILLE GRAND RAPIDS WACO NEW ORLEANS IA TN MI TX LA 50309 37229 49501 76702 70163 PRIVATE HEALTHCARE SYSTEMS PRO-AMERIA INSURANCE PRO-CLAIM PLUS, INC. PRO-MARK PRODUCERS EXCHANGE BENEFIT SERVICES INC. 3509-00 2829-00 3191-00 2891-00 2545-00 HENDERSONVILLE FT.WORTH FORT WAYNE PEACE DALE IRVING TN TX IN RI TX 37077 76101 46899 02883 75038 PRODUCTION MANAGEMENT COMPANIES INC PROFESSIONAL ADMINISTRATION GROUP 2222-00 2085-00 HARVEY OVERLAND PARK LA KS 70059 66212 PROFESSIONAL BENEFIT ADMINISTRATORS PROFESSIONAL BENEFITS INSURANCE COMPANY PROFESSIONAL CLAIMS MANAGEMENT PROFESSIONAL INS. CORP. PROFESSIONAL INVESTORS LIFE INS. CO. PROFESSIONAL SERVICE INDUSTRIES INC PROGRESSIVE COUNTY MUTAL INSURANCE 2468-00 1538-00 2400-00 0387-00 0388-00 1809-00 1592-00 HINSDALE HOUSTON CANTON JACKSONVILLE TULSA SPRINGFIELD HURST IL TX OH FL OK IL TX 60521 77099 44735 32202 74101 62708 76053 PROGRESSIVE DRIVER SEVICES INC PROGRESSIVE EMPLOYER'S ASSOC. TRUST PROMINA NW HEALTH NETWORK 2622-00 1482-00 2846-00 1111 ASHWORTH ROAD P O BOX 51005 146 INDUSTRIAL PARK POST OFFICE BOX 33999 8278 WILLETT PKWY P O BOX 13896 P O BOX 509075 P O BOX 509075 BOX 340 8035 ERL THORTON EXPWY P O BOX 171816 P O BOX 8002 P O BOX 11088 P O BOX 1323 P O BOX 323 P O BOX 64812 3120 BRECKINRIDGE BLVD P O BOX 39710 10103 FONDREN SUITE 500 P O BOX 795014 1 NORTH PENNSYLVANIA ST P O BOX 8175 P O BOX 39710 2431 S ACAIDAN THRUWAY SUITE 290 711 HIGH ST P O BOX 290249 P O BOX 232 P O BOX 2650 1100 POYDRAS ST STE 2600 P O BOX 1439 P O BOX 901037 P O BOX 9648 P O BOX 3704 5525 MACARTHUR BLVD SUITE 350 P O BOX 44 P O BOX 13390 8500 W 110TH ST/STE 650 201 E OGDEN AVE/STE 120 10835 ROCKLEY ROAD P O BOX 35276 135 RIVERSIDE AVENUE POST OFFICE BOX 2888 P O BOX 3041 301 NORTHEAST LOOP 820 SUITE 205 P O BOX 17775 215 N MAIN ST 1000 CIRCLE 75 PKWY STE 480 JACKSONVILLE CLARION ATLANTA FL IA GA 32245 50525 30339 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 68 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP PRONET PROSOURCE, INC, LIFEWELL HEALTH PLAN S 3100-00 3065-00 FORT WORTH KENNESAW TX GA 76185 30144 PROTECTED HOME MUTUAL LIFE INS. CO. PROTECTIVE CASUALTY INS. CO. PROTECTIVE LIFE INS. CO. PROTECTIVE SERVICE LIFE INSURANCE PROVANTAGE PROVIDENCE LIFE INS CO PROVIDENCE THRU WHITE CONSOLIDATED INDU WCI POULAN 0389-00 1460-00 0390-00 1011-00 2895-00 1794-00 1189-00 SHARON BATON ROUGE BIRMINGHAM JACKSON BROOKFIELD METAIRIE SHREVEPORT PA LA AL MS WI LA LA 16146 70814 35223 39201 53008 70001 71139 PROVIDENT PROVIDENT PROVIDENT PROVIDENT PROVIDENT PROVIDENT PROVIDENT ALLIANCE LIFE INS. CO. AMERICAN INSURANCE CO. INDEMNITY LIFE INS. CO. INSURANCE LIFE AND ACCIDENT LIFE AND ACCIDENT INS CO LIFE AND ACCIDENT INS. CO. 0391-00 0392-00 0393-00 0754-00 1135-00 0394-01 0394-00 NEWPORT BEACH DALLAS BRISTOL MEMPHIS GREENSBORO HOUSTON CHATTANOOGA CA TX TN TN NC TX TN 92663 75231 37621 38137 27404 77218 37402 PROVIDENT LIFE AND ACCIDENT INSURANCE CO PROVIDENT MUTUAL LIFE INS OF TAMPA PROVIDENT MUTUAL LIFE INS. CO. OF PHILADELPHIA PROVIDENTIAL LIFE INSURANCE CO PROVIDERS FIDELITY INS. CO. PROVINCE HEALTH CARE PRU-CARE OF NORTH TEXAS 0845-00 0395-01 0395-00 0814-00 1439-00 3071-00 1287-00 BIRMINGHAM TAMPA PHILADELPHIA LITTLE ROCK BLUE BELLE HENDERSONVILLE DALLAS AL FL PA AR PA TN TX 35216 33630 19101 72203 19422 37077 75206 PRUCARE PLUS PRUCO LIFE INSURANCE CO OF TEXAS 2104-00 2407-00 JACKSONVILLE AUSTIN FL TX 32231 78711 PRUDENTIAL INS. CO. OF AMERICA PRUDENTIAL-KROGER BENEFIT PLAN PTRX PUBLIC INVESTORS LIFE INS. CO. PUBLIC AMERICAN LIFE INSURANCE CO PUBLIC EDUCATION EMPLOYEES HEALTH INSURANCE PLAN PUBLIC EMPLOYEE HEALTH PLAN PURINA BENEFITS ASSOCIATION PURITAN LIFE INS. CO. PYRAMID LIFE PYRAMID LIFE INS CO THE PYRAMID LIFE INS. CO., THE Q-DENT DENTAL MANAGEMENT CORP QBE INSURANCE CORPORATION 0396-00 0396-01 3887-00 0397-00 1664-00 2194-00 2549-00 2280-00 0398-00 3687-00 3882-00 0399-00 2067-00 3430-00 HOUSTON JACKSONVILLE SAN ANTONIO ALEXANDRIA DALLAS BIRMINGHAM SALT LAKE CITY ST.LOUIS PROVIDENCE HOUSTON PENSACOLA SHAWNEE MISSION DENHAM SPRINGS NEW YORK TX FL TX LA TX AL UT MO RI TX FL KS LA NY 77210 32231 78249 71301 75247 35205 84102 63164 02940 77274 32591 66201 70726 10005 QUAL MED 2880-00 ALBUQUERQUE NM 87110 QUALCHOICE QUALITY BENEFITS 3668-00 3270-00 LITTLE ROCK ST PETERS AR MO 72221 66376 QUALITY PROCESS SERVICE 3698-00 P O BOX 101387 1701 BARRETT LAKE BLVD SUITE 290 30 EAST STATE STREET 10033 MAMMOTH AVE 2801 HIGHWAY 280 SOUTH 600 EAST AMITE ST P O BOX 846 808 L & A RD WEEDEATER SELF INSURED P O BOX 9328 POST OFFICE BOX 1770 P O BOX 679005 P O BOX 8915 P O BOX 171806 P O BOX 10307 P O BOX 219788 FOUNTAIN SQUARE PROVIDENT BUILDING PO BOX 20468 P O BOX 30078 POST OFFICE BOX 7378 P O BOX 8072 POST OFFICE BOX 1120 P O BOX 1439 6060 N CENTRAL EXPRESSWAY SUITE 750 P O BOX 44097 P O BOX 12487 CAPITOL STATION P O BOX 4587 P O BOX 44109 4590 LOCKHILL SELMA POST OFFICE BOX 5484 8585 STEMMONS FREEWAY 2160 HIGHLAND AVE 560 EAST 200 SOUTH 835 S 8TH ST POST OFFICE BOX 9200 P O BOX 742568 P O BOX 130 POST OFFICE BOX 772 P O BOX 735 88 PINE STREET 16TH FLOOR 6100 UPTOWN BLVD NE SUITE 400 P O BOX 25601 1421 TRIAD CENTER STE B P O BOX 14610 LEXINGTON KY 40512 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 69 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP QUARLES DRILLING CORP. GROUP MEDICAL PLAN QUIKRETE & AFFILIATED MED BENEFITS TRUST R H ADMINISTRATORS, INC. 2621-00 2054-00 3424-00 TULSA NORFOLK LUBBOCK OK VA TX 74133 23502 79414 RABENHORST INDUSTRIAL LIFE INS CO RACELAND SUGAR AGRICULTURE (SELF-INSURED) RAILROAD RETIREMENT BOARD RAILROAD RETIREMENT BOARD RALPH'S OF LAFAYETTE RAMSAY HEALTH CARE INC BENEFIT PLAN RAMSEY HEALTH CARE INS. RANDALL'S HEALTH PLAN RAPIDES PARISH POLICE JURY RAPIDES REGIONAL MED CTR GROUP HEALTH PLAN RAYNE STATE BANK AND TRUST CO. RBMS RBMS LLC DBA/RISK&MGMT RCA PLAN FOR HEALTH RE MEMBER GROUP HOSPITAL INSURANCE READING AND BATES INSURANCE CO REASSURE AMERICA RED BALL OXYGEN MEDICAL TRUST 1515-00 2277-00 1760-00 H420-50 2024-00 2515-00 2541-00 2180-00 0963-00 2319-00 2763-00 3636-00 3634-00 1433-00 1977-00 1024-00 3105-00 1639-00 BATON ROUGE RACELAND AGUSTA AUGUSTA LAFAYETTE NEW ORLEANS CORAL GABLES HOUSTON ALEXANDRIA ALEXANDRIA SHREVEPORT ANCHORAGE ANCHORAGE VAN NUYS LINCOLN TULSA DALLAS SHREVEPORT LA LA GA GA LA LA FL TX LA LA LA AK AK CA NE OK TX LA 70802 70394 30999 30999 70506 70156 33114 77210 71303 71301 71137 99524 99524 91409 68506 74103 75374 71107 REGAL MEDICAL CARE PLAN REGENCE LIFE & HEALTH INSURANCE COMPANY REGINA COELI CHILD DEVELOPMENT CENTER 1665-00 2975-00 2418-00 JACKSONVILLE PORTLAND COVINGTON AR OR LA 72076 97207 70433 REGIONAL HEALTH PLAN REGIT RELIABLE LIFE INS. CO. RELIANCE STANDARD LIFE CO RELIANCE STANDARD LIFE INS. CO. 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RESOURCE BENEFITS ADMINISTRATORS RESOURCEONE ADMINISTRATORS RESTAT GOLDEN FLAKE PHARMACY PLAN RETAIL CLERK WELFARE TRUST RETIRED FEDERAL EMPLOYEES HEALTH BENEFITS ACT RETIRED MACHINISTS HEALTH PLAN RETIREE MEDICAL INSURANCE 0405-00 0406-00 3704-00 3410-00 2516-00 2598-00 1002-00 2817-00 3724-00 7633 E 63RD/STE 500 P O DRAWER 12569 5502 58TH ST SUITE 700 833 GOVERNMENT P O BOX 159 P O BOX 10066 P O BOX 1066 3112 CAMERON ST P O BOX 56549 P O BOX 145086 P O BOX 4506 BOX 1150 211 FOURTH ST P O BOX 70100 P O BOX 24159 P O BOX 24159 P O BOX 9126 P O BOX 6963 2200 MID CONTINENT TOWER P O BOX 749014 SELF-INSURED P O BOX 7316 1100 REDMOND RD P O BOX 1071 832 E BOSTON #10 P O BOX 9062 P O BOX 1085 108 N. 23RD STREET P O BOX 82510 2501 PARKWAY P O BOX 1195 1205 WINDHAM PARKWAY 8585 STEMMONS FREEWAY STE 1101 8585 STEMMONS FRWY POST OFFICE BOX 223647 POST OFFICE BOX 226210 POST OFFICE BOX 223000 ALPHA DATA SYSTEMS,INC P O BOX 791428 403 SOUTH AKARD STREET 6100 NORTH GRAND BLVD P O BOX 27 P O BOX 4830 P O BOX 758 P O BOX 2265 P O BOX 14172 P O BOX 24263 P O BOX 10432 DALLAS OKLAHOMA CITY CEDARVILLE TULSA WEST BEND SEATTLE WASHINGTON OAKLAND DES MOINES TX OK OH OK WI WA DC CA IA 75222 73118 45314 74159 53095 98111 20044 94623 50306 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 70 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP REVCO D S INC REYNOLDS METALS CO RICHARDSON MEDICAL CENTER RILEY-BEAIRD 0981-00 1769-00 2690-00 0919-00 TWINSBURG RICHMOND RAYVILLE SHREVEPORT OH VA LA LA 44087 23261 71269 71130 RISK FUNDING RISK MANAGEMENT INC RISK MANAGEMENT INC RITE AID HEALTH SOLUTIONS RIVERLAND MEDICAL CENTER EMERGENCY MEDICAL SERVICE RIVERSIDE LIFE INS. CO. RLC-CORPORATION-EMPLOYEE BENEFIT TRUST RMSCO INC ROADWAY SERVICES INC 2250-00 1080-00 2544-00 3789-00 2737-00 0407-00 1464-00 2202-00 2295-00 TYLER BATON ROUGE BATON ROUGE CAMP HILL FERRIDAY NEW ORLEANS WILMINGTON SYRACUSE AKRON TX LA LA PA LA LA DE NY OH 75713 70898 70898 17011 71334 70152 19899 13203 44309 ROBERT C. BOWCK INC ROBERT S WEISS CO ROBEY BARBER INSURANCE CORPORATION ROBINSON & JULIENNE BAILEY COMPANY ROBINSON-CONNER INSURANCE ROCKWOOD INSURANCE CO ROLLINS ENVIRONMENTAL SERVICES EMPLOYEE BENEFIT TRUST ROLLINS INC ROSEWOOD NURSING CENTER INC (SELF-INSURED) ROWAN COMPANIES INC 2106-00 1620-00 1361-00 1476-00 1783-00 1976-00 1672-00 1386-00 1957-00 1776-00 LEAWOOD STAMFORD TAMPA JACKSON ERIE NOBLESVILLE WILMINGTON ATLANTA LAKE CHARLES HOUSTON KS CT FL MS PA IN DE GA LA TX 66200 06901 33629 39206 16501 46060 19899 30301 70601 77056 ROYAL NEIGHBORS OF AMERICA RR MAINT & INDU HLTH & WELFARE FUND RSI CONSTRUCTION RSL SPECIALTY PRODUCTS 3468-00 3607-00 2143-00 3828-00 CLEARWATER SPRINGFIELD SHREVEPORT MOORESTOWN FL IL LA NJ 33757 62704 71135 05087 RUBY TUESDAY, INC. 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NET INSURANCE CO LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 71 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP SAFEWAY GROUP BENEFITS SAIPLUS 2512-00 3017-00 OAKLAND ROCKVILLE CA MD 94604 20850 SAMBA (CIGNA) SAMMONS MEDICAL EXPENSE 3753-00 3379-00 SCRANTON DALLAS PA TX 18505 75207 SAN DIEGO ELECTRICAL TRUST SAN FRANCISCO ADMINISTRATORS SAN FRANCISCO PRINTING INDUSTRY WELFARE FUND SANDERS EMPLOYEE BENEFIT PLAN SANDERSON FARMS INC SANTA FE EMPLOYEES HOSPITAL ASSOC SANTA FE INTERNATIONAL CORPORATION SANUSPLUS 3196-00 2674-00 1436-00 2454-00 2495-00 3233-00 1179-00 1951-00 SAN DIEGO SAN FRANCISCO SAN FRANCISCO TROY LAUREL COVINA LAFAYETTE HOUSTON CA CA CA AL MS CA LA TX 92194 94107 94120 36081 39441 91723 70505 77098 SAVANNAH FOODS & INDUSTRIES INC SAVE RX SAVERS LIFE INS. CO. SAVINGS LIFE INS. CO. SAVOY MEDICAL CENTER(SELF-INSURED) SAWYER DRILLING & SERVICE INC.(SELF-INSURED) SC UNITED FOOD COMM WKRS UNIONS EMP HLT WEL TRUST SCHAD INDUSTRIES BENEFIT TRUST SCHALLER ANDERSON HEALTHCARE SCHLUMBERGER GROUP HEALTH CARE TRUST SCHOEN LIFE INS CO INC SCHULLER INTERNATIONAL,INC SCHUMPERT MEDICAL CENTER-BENEFLEX-SCH CLAIMS 2273-00 3246-00 2738-00 0411-00 1255-00 2020-00 1143-00 2476-00 3164-00 0896-00 0789-00 2920-00 1722-00 SAVANNAH FREEMONT WINSTON-SALEM SHREVEPORT MAMOU SHREVEPORT MESQUITE OPELOUSAS BOSSIER CITY SHERMAN NEW ORLEANS RICHARDSON SHREVEPORT GA NE NC LA LA LA TX LA LA TX LA TX LA 31402 68026 27116 71130 70554 71101 75150 70571 71171 75090 70179 75083 71120 SCOTSMAN INSURANCE CO-EMPLOYEE GROUP COVERAGE SCOTT AND WHITE HEALTH PLAN SCREEN ACTORS GUILD 0933-00 1141-00 1839-00 SANTA ROSE TEMPLE BURBANK CA TX CA 95406 76508 91510 SCRIPT CARE INC SCRIPT CARE, LTD. 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SECURITY FIRST TRUST 0866-00 3539-00 2470-00 1015-00 3619-00 3927-00 0412-00 0413-00 1902-00 P O BOX 2099 1803 RESEARCH BLVD STE 402 P O BOX 6010 2777 N STEMMONS FAIRWAY STE 1525 P O BOX 231219 501 SECOND ST #212 P O BOX 7051 P O DRAWER 707 P O BOX 988 551 EAST SAN BERNADINO RD P O BOX 5272 3800 BUFFALO SPDWY P O BOX 56228 P O BOX 339 P O BOX 8 P O BOX 11947 POST OFFICE BOX 33999 801 POINCIANA AVE 220 TRAVIS/STE 500 3218 E HWY 67 SUITE 120 P O BOX 591 P O BOX 71200 P O BOX 2546 P O BOX 19263 PO BOX 833823 HEALTH ADVANTAGE P O BOX 22255 P O BOX 6675 2401 SOUTH 31ST ST 3601 WEST OLIVE AVE P O BOX 7830 87 IH NORTH, SUITE 100 6380 FOLSOM DR 525 S MERIDIAN 1750 WILLIAMS CT TOWER 2 TWO WEST 2ND ST P O BOX 380 SEAFARERS INTERNATL UNION 5201 AUTHWAY PO BOX 17805 2601 RESEARCH BLVD P O BOX 41573 P O BOX 1717 P O BOX 31353 P O BOX 12466 105 SOUTH 17TH STREET 700 HARRISON INS.RESOURCES MANAGEMENT P O BOX 4705 JACKSONVILLE THE WOODLANDS PHILADELPHIA VALLEY FORGE SALT LAKE CITY PENSACOLA OMAHA TOPEKA MONROE FL TX PA PA UT FL NE KS LA 32245 77381 19101 19482 84131 32591 68102 66603 71211 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 72 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP SECURITY GENERAL LIFE INS. CO. SECURITY INDUSTRIAL INS. CO. SECURITY LIFE INS. CO. OF AMERICA SECURITY LIFE OF DENVER INS. CO. SECURITY SOUTHWEST LIFE INS. CO. SECURITY TRUST LIFE SECURITY-CONNECTICUT LIFE INS. CO. SEDGWICK JAMES INC SEDGWICK NOBLE NOWLDS SEIBERT-KECK AGENCY SELECT BENEFIT ADMIN. OF AMERICA SELECT CARE OF TEXAS SELECT EMPLOYERS INSURANCE TRUST SELECT HORIZONS SELF FUNDING ADMINISTRATORS SELF FUNDING ADMINSTRATORS SELF INSURANCE ADMINISTRATORS INC SELF INSURANCE INC SELF INSURED SERVICES CO (SISCO) SELF-FUNDED PLANS,INC (PEPSI-COLA,7-UP 0415-00 0416-00 0418-00 0417-00 0419-00 1003-00 0414-00 2602-00 2735-00 1606-00 3411-00 H450-60 1213-00 3500-00 3942-00 2364-00 1622-00 0732-00 1998-00 0937-00 OKLAHOMA CITY DONALDSONVILLE RICHARDSON DENVER EL PASO MACON AVON JACKSON WARMINISTER AKRON ASHLAND HOUSTON NEW ORLEANS SALT LAKE CITY ANNAPOLIS CLEARWATER LAFAYETTE ST MARTINVILLE DUBUQUE CLEVELAND OK LA TX CO TX GA CT MS PA OH WI TX LA UT MD FL LA LA IA OH 73154 70346 75083 80202 79950 31297 06001 39225 18974 44313 54806 77081 70181 84131 21401 34620 70598 70582 52004 44114 SEMOLINA INC DAY ONE MEDICAL PLAN SENIOR AMERICAN GROUP INSURANCE TRUST SENIOR CARE SENIOR SECURITY PRESCRIPTION PLAN SENTARA HEALTH PLANS INC SENTARA HEALTHCARE SENTINEL INSURANCE GROUP SENTINEL SECURITY LIFE INS CO SENTRY LIFE INS. CO. 3158-00 2121-00 3190-00 3252-00 3362-00 3892-00 2080-00 3835-00 0420-00 FORT WORTH PHILADELPHIA TALLULAH VALLEY FORGE VIRGINIA BEACH NORFOLK BETHLEHEM CLEARWATER STEVENS POINT TX PA LA PA VA VA PA FL WI 76147 19102 71284 19482 23462 23502 18017 33766 54481 SEPCO INDUSTRIES INC SERVICE EMPLOYEES INTERNATIONAL UNION 2321-00 1767-00 HOUSTON WASHINGTON TX DC 77002 20090 SERVICES DISTRIBUTED SETON HEALTH PLAN SEVEN CORNERS SHARED MEDICAL ALTERNTAIVES SHASTA ADIMINISTRATIVE SERVICES SHAW INDUSTRIES SHEARMAN CORPORATION DBA SHEER METAL WORKERS LOCAL NO 361 WELFARE FUND SHEET METAL WORKER NATIONAL HEALTH FUND SHEET METAL WORKER'S INT.,LOCAL 265 SHEET METAL WORKERS WELFARE PLAN 2023-00 3333-00 3483-00 3068-00 3821-00 2334-00 2385-00 1016-00 1703-00 1707-00 0953-00 LAFAYETTE AUSTIN CARMEL RIVERSIDE REDMOND THOMSON LAKE CHARLES SHREVEPORT ALEXANDRIA CAROL STREAM LOS ANGELES LA TX IN CA OR GA LA LA VA IL CA 70502 78761 46082 92517 97756 30824 70602 71103 22314 60188 90076 SHELTER LIFE INS. CO. SHENANDOAH LIFE 0421-00 1419-00 COLUMBIA BATON ROUGE MO LA 65201 70898 SHERIFF'S GROUP BENEFITS PROGRAM SHERMAN CORP 2365-00 2217-00 POST OFFICE BOX 18810 110 RAILROAD AVENUE P O BOX 836150 SECURITY LIFE BUILDING POST OFFICE BOX 1889 P O BOX 4287 SECURITY DRIVE P O BOX 24117 P O BOX C 5009-0580 2950 W MARKET ST P O BOX 440 4888 LOOP CENTRAL DR P O BOX 10533 P O BOX 31353 P O BOX 6596 14440 MYERLAKE CIRCLE P O BOX 81189 305 WASHINGTON ST P O BOX 389 OF LAKE CHARLES) 1432 HAMILTON AVE P O BOX 9137 2 PENN CENTER PLAZA 900 JOHNSON ST P O BOX 1340 4417 CORPORATION LN 6015 POPLAR HALL DR 3900 BURGESS RD P O BOX 16960 BOX 1700 ATTEN GROUP HEALTH CLAIMS 440 LOUISIANA ST HEALTH & WELFARE FUND P O BOX 90980 P O BOX 3090 P O BOX 15507 P O BOX 3430 P O BOX 51098 P O BOX 1747 P O BOX 960 P O BOX 2893 2515 FULTON 601 N FAIRFAX ST 106 N SCHMALE RD SOUTH CALIFORNIA PO BOX 76886 1817 WEST BROADWAY ALPHA CORPORATION P O BOX 14786 300 IBERIA ST/STE 120 P O BOX 2893 NEW IBERIA LAKE CHARLES LA LA 70560 70602 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 73 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP SHETFIELD OLSON & MCQUEEN SHIELD OF SHELTER SHONEY'S (SELF-INSURED) SHREVEPORT ELECTRICAL HEALTH & WELFARE FUND SIBLING FINANCIAL CORP 3364-00 1172-00 1913-00 1111-02 2064-00 ST PAUL BATON ROUGE NASHVILLE SHREVEPORT SHREVEPORT MN LA TN LA LA 55116 70806 37229 71129 71105 SIERRA HEALTH & LIFE INSURANCE SIERRA HEALTH AND LIFE SIERRA VILLAGE HEALTH SIGNAL MUTUAL INS CO SIGNATURE DENTAL PLAN SILVERSCRIPT SILVERSTONE GROUP 3678-00 2755-00 H290-50 1223-00 2654-00 3360-00 3067-00 LAS VEGAS JACKSON LAS VEGAS BEAUMONT SCHAUMBURG PHOENIX OMAHA NV MS NV TX IL AZ NE 89114 39208 89114 77704 60173 85072 68154 SIMMONS GROUP MEDICAL SIMPLE INSURANCE 3669-00 1523-00 ROGERS LOS ANGELES AR CA 72757 90067 SIMPLEX TIME RECORDER SELF INSURED AS COMPLETE 1194-00 GARDNER MA 01441 SIMPLY HEALTH CARE SINCLAIR SISCO SISTERS OF CHARITY OF THE INCARNATE WORK HLT PLAN SISTERS OF THE HOLY FAMILY SKILSTAF SKYLINE CORPORATION 3988-00 3928-00 3438-00 1025-00 2873-00 3157-00 2305-00 EAGAN SALT LAKE CITY DUBUQUE COLORADO SPRINGS NEW ORLEANS ALEXANDER CITY ELKHART MN UT IA CO LA AL IN 55121 84130 52004 80901 70126 35011 46515 SLIDELL MEMORIAL HOSPITAL EMPLOYEE HEALTH PLAN SMA LIFE ASSURANCE CO. SMALL BUSINESS MAN'S INSURANCE ASSOCIATION SMC INC SMITH ADMINISTRATORS SNL ADMINISTRATORS SOCIETY NATIONAL GROUP - HEALTH TECH DYNAMICS SOI HEALTH PLANS SONAT,INC SONITROL MANAGEMENT CORP SONOCO PRODUCTS COMPANY 2919-00 0408-00 2906-00 2991-00 3370-00 2684-00 1000-00 3372-00 0995-00 2061-00 2768-00 SLIDELL WORCESTER DENHAM SPRINGS SEARCY RICHARDSON WARMINSTER INDIANAPOLIS CHARLOTTE BIRMINGHAM INDIANAPOLIS GREENSBORO LA MA LA AR TX PA IN NC AL IN NC 70458 01605 70726 72145 75085 18974 45268 28224 35202 46205 27409 SOONER INSURANCE 2790-00 OKLAHOMA CITY OK 73112 SOUTH SOUTH SOUTH SOUTH 2147-00 3751-00 1208-00 3720-00 2145 FORD PKWY #300 1956 BEAUMONT DR P O BOX 290489 5510 BUNCOMBE RD 310 KNIGHT ST SUITE 300 P O BOX 15645 2506 LAKELAND DR #402 P O BOX 15645 P O BOX 3463 200 N MARTINGALE RD P O BOX 52066 11516 MIRACLE HILLS DR SUITE 102 P O BOX 1627 COMMERCIAL SALES & SERV 1801 AVE OF THE STARS CARE CONTROL SIMPLEX PLAZA P O BOX 21535 P O BOX 30827 P O BOX 389 P O BOX 529 6901 CHEF MENTEUR HWY P O BOX 729 2520 BYPASS RD P O BOX 743 1051 GAUSE BLVD 225 440 LINCOLN STREET 8281 LAFAYETTE ST P O DRAWER 1979 P O BOX 853937 P O BOX C5009 9101 WESTLEYAN RD P O BOX 241508 PO BOX 2563 P O BOX 55210 7025 ALBERT PICK RD 5TH FLOOR 3555 NW 58TH ST #400 8720 RED OAK BLVD/STE 227 P O BOX 90802 1451 EAST OCEAN BLVD 12160 N ABRAMS RD SUITE 201 9550 SKILLMAN SUITE 410 3218 EAST HWY 67 SUITE 120 P O BOX 159 CHARLOTTE LUBBOCK VERO BEACH DALLAS NC TX FL TX 28217 79408 33494 75243 DALLAS TX 75243 MESQUITE TX 75150 RACELAND LA 70394 CAROLINA LOCAL GOVERNMENT ASSURANCE GRP CENTRAL (UFCW-PPO PLUS) CENTRAL EDUCATION RISK MANAGEMENT PROG CENTRAL HEALTH SOUTH CENTRAL HEALTH & WELFARE TRUST 2195-00 SOUTH CENTRAL UNITED FOOD COMMERCIAL WORKERS UNION 1469-00 SOUTH COAST SUGARS (SELF-INSURED) 2140-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 74 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP SOUTH LA. 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SOUTHERN BAPTIST HOSPITAL 1812-00 0820-00 0422-00 0513-00 SHREVEPORT JACKSON SHREVEPORT NEW ORLEANS LA MS LA LA 71135 35211 71130 70115 SOUTHERN BENEFIT ADMINISTRATORS IN SOUTHERN BENEFIT CONSULTANTS INC SOUTHERN BENEFIT SERVICES 3557-00 2118-00 3682-00 GODLETTSVILLE IRVING KENNER TN TX LA 37070 75039 70062 SOUTHERN SOUTHERN SOUTHERN SOUTHERN SOUTHERN BENEFIT SERVICES BENEFITS SERVICES,INC CALIFORNIA IBEW NECA HEALTH FUND CALIFORNIA PIPE TRADE TRUST FUND CARE ENTERPRISES 3749-00 1062-00 1039-00 1917-00 1736-00 BUCKEYSTOWN BIRMINGHAM LOS ANGELES LOS ANGELES TUCKER MD AL CA CA GA 21717 35202 90031 90020 30084 SOUTHERN SOUTHERN SOUTHERN SOUTHERN SOUTHERN SOUTHERN SOUTHERN SOUTHERN SOUTHERN SOUTHERN COUNCIL OF INDUSTRIAL WORKERS ELECTRIC HEALTH FUND FARM BUREAU CASUALTY INS. CO. FARM BUREAU LIFE INS. CO. FARMERS ASSOCIATION INC FARMERS ASSOCIATION,INC FIDELITY LIFE INSURANCE CO. 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SUITE 414 P O BOX 9159 P O BOX 20046 407 BIENVILLE ST 151 WYMORE ROAD STE. 450 SELF INSURED P O BOX 1268 SHREVEPORT ST.PETERSBURG NATCHITOCHES ALTAMONTE SPRINGS LA FL LA FL 71139 33742 71457 32701 OPELOUSAS LA 70570 SOUTHERN STANDARD FITTINGS 1408-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 75 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP SOUTHERN STATES HEALTH & WELFARE FUND SOUTHERN TEXAS LABORER'S DISTRICT COUNCIL 1178-00 2590-00 OAK PARK HOUSTON MI TX 48237 77084 SOUTHERN TIRE MART SOUTHERN UNITED LIFE INS. CO. SOUTHLAND EMPLOYEES WELF TRUST SOUTHMARK HERITAGE SOUTHWEST ADMINISTRATORS 3268-00 0428-00 0429-00 1388-00 1111-00 SHREVEPORT MONTGOMERY DALLAS SHREVEPORT BOSSIER CITY LA AL TX LA LA 71119 36104 75221 71130 71111 SOUTHWEST HEALTH CLAIMS SERVICE SOUTHWEST HOME LIFE 1733-00 1309-00 SAN ANTONIO AUSTIN TX TX 78229 78759 SOUTHWEST LOUISIANA ELECTRICAL WELFARE FUND SOUTHWEST PREFERRED HEALTH NETWORK,INC 1073-00 1077-00 LAKE CHARLES DALLAS LA TX 70601 75244 SOUTHWEST REGIONAL COUNCIL 1322-00 DALLAS TX 75354 SOUTHWEST RESEARCH INSURANCE COMPANY 1010-00 SAN ANTONIO TX 78284 SOUTHWEST SERVICE LIFE INSURANCE COMPANY SOUTHWEST, AN AETNA HEALTH PLAN SOUTHWESTERN ADMINISTRATORS SOUTHWESTERN ELECTRIC POWER (SELF-INSURED) SOUTHWESTERN LIFE INS. CO. SOUTHWESTERN MOTOR TRANSPORT SOUTHWESTERN SECURITY SERVICES INC 1121-00 2432-00 2743-00 2032-00 0430-00 2434-00 3442-00 FORT WORTH IRVING BOSSIER CITY SHREVEPORT DALLAS SAN ANTONIO BURLINGAME TX TX LA LA TX TX CA 76118 75014 71111 71156 75221 78218 94010 SPECIAL AGENT MUTUAL BENEFIT ASSOC (SAMBA) SPECIAL AGENT MUTUAL BENEFIT ASSOCIATION SPECIAL INSURANCE SERVICES SPECIALTY FOOD SYSTEMS 2128-40 2184-00 3547-00 3135-00 NORTH BETHESDA NORTH BETHESDA PLANO SLIDELL MD MD TX LA 20852 20852 75025 70459 SPECIALTY MACHINE & SUPPLY INC SPECIALTY OIL COMPANY SPECTERA UNITED OPTICAL SPRADLEY & COKER INSURANCE CO. SPRINGFIELD LIFE INS. CO., INC. SRX PHARMACY SPECIALIST ST FRANCIS CABRINI HOSP CLAIMS ADMINISTRATION 2625-00 1999-00 3002-00 1092-00 0431-00 2869-00 1644-00 SCOTT SHREVEPORT BALTIMORE ELDORADO SPRINGFIELD MENTOR HOUSTON LA LA MD AR MA OH TX 70583 71136 21244 71730 01133 44061 77292 ST ST ST ST ST FRANCIS HOSPITAL INSURANCE SYSTEM,INC JAMES PARISH COUNCIL JOHNS CLAIMS ADMINISTRATION JOHNS CLAIMS ADMINISTRATIONS MARTIN PARISH SCHOOL BOARD/SELF 1330-00 1393-00 3781-00 3208-00 0890-00 JACKSON CONVENT SPRINGFIELD SPRINGFIELD NEW IBERIA MS LA MO MO LA 39211 70723 65814 65814 70560 ST. CHARLES PARISH SCHOOL BOARD ST. PAUL LIFE INS. CO. ST.LANDRY PARISH SCHOOL BOARD(SELF-INSURED) STAFFING CONCEPTS 2536-00 0410-00 1924-00 2730-00 P O BOX 37503 HEALTH AND WELFARE TRUST 16225 PARK TEN PLACE #460 7320 GREENWOOD RD 116 CATOMA STREET P O BOX 711 P O BOX 33888 315 MONROE ST SUITE B P O BOX 29098 8140 MOPAC EXPRESWAY WEST PARK 4 SUITE 205 1715 COMMON ST 4020 MC EWEN DR. SUITE 280 P O BOX 542814 PH# 214-358-7551 (SELF-INSURED PROGRAM) P O BOX 28510 P O BOX 18600 P O BOX 141239 1400 C BARKSDALE BLVD P O BOX 21106 POST OFFICE BOX 2699 4600 GOLDFIELD 887 MITTEN RD STE 200 11301 OLD GEORGETOWN RD 11301 OLD GEORGETOWN RD P O BOX 250349 P O BOX 4130 1320 LAKEWOOD DR P O BOX 606 P O BOX 6860 2811 LORD BALTIMORE DR 200 PEACH ST 1250 STATE STREET P O BOX 1389 2600 N LOOP WEST/STE 520 P O BOX 922013 P O BOX 12830 COURTHOUSE BLDG P O BOX 14230 P O BOX 14409 INSURED ADMINISTRATORS P O BOX 9670 P O BOX 46 385 WASHINGTON STREET P O BOX 310 4350 W CYPRESS ST SUITE 900 LULING ST. PAUL OPELOUSAS TAMPA LA MN LA FL 70070 55102 70571 33607 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 76 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP STANDARD LIFE AND ACCIDENT INS CO STANDARD LIFE AND ACCIDENT INS. CO. STANDARD LIFE AND CASUALTY INS. CO. STANDARD LIFE INS. CO. STANDARD OF AMERICA LIFE INS. CO., THE STANDARD REGISTER GROUP HEALTH CLAIMS STANDARD SECURITY LIFE INS. CO. OF NY STAR BENEFITS STAR MARKETING ADMINISTRATION INS. CO. STARBRIDGE STARMARK CLAIMS STARMOUNT DENTAL STATE BANK & TRUST CO. STATE BAR OF TEXAS INSURANCE TRUST STATE FARM STATE FARM HEALTH INSURANCE STATE GROUP BENEFITS STATE HEALTH BENEFIT PLAN STATE LIFE INS. CO., THE STATE MUTUAL COM STATE MUTUAL INSURANCE COMPANY 3871-00 0433-00 0434-00 0435-00 0432-00 2531-00 0436-00 2030-00 1521-00 2698-00 3674-00 3112-00 2520-00 2740-00 0702-00 3632-00 3905-00 1291-00 0437-00 1610-00 3061-00 SAN ANTONIO OKLAHOMA CITY ROCK HILL JACKSON PARK RIDGE DAYTON NEW YORK PHOENIX DES PLAINES PHOENIX CLINTON BATON ROUGE SHREVEPORT AUSTIN NEWARK GREELEY BATON ROUGE ATLANTA INDIANAPOLIS WORCESTER CLEARWATER TX OK SC MS IL OH NY AZ IL AZ IA LA LA TX OH CO LA GA IN MA FL 78269 73193 29730 39205 60068 45401 10022 85051 60018 85078 52733 70898 71137 78711 43058 80633 70896 30334 46206 01605 33755 STATE STATE STATE STATE STATE 0438-00 0439-00 2423-00 1543-00 2805-00 P O BOX 696800 421 NORTHWEST 13TH STREET POST OFFICE BOX 11677 POST OFFICE BOX 1729 EXECUTIVE PLAZA P O BOX 1167 485 MADISON AVENUE 7122 N 27TH AVE/STE 200 1400 EAST TOUHY ST. 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OF AMERICA NATIONAL LIFE INS. CO. OF ALABAMA OF FLORIDA EMPLOYEE GRP HLTH SELF-INS OF MISSISSIPPI STATE OF N CAROLINA COMPREHENSIVE MED PLAN STATE RESERVE LIFE INS. CO. STATES GENERAL LIFE INS. CO. STATESMAN NATIONAL LIFE INS. CO., THE STERLING INVESTORS LIFE INSURANCE STERLING LIFE INSURANCE COMPANY STERLING OPTION II STERLING OPTION II STERLING OPTION ONE STEVE D THOMPSON TRUCKING CO STEWART & STEVENSON MUTUALLY PREFERRED STEWART SANDWICHES INC 1249-00 0440-00 0441-00 0442-00 3568-00 1227-00 3863-00 3686-00 H500-60 0980-00 2687-00 1629-00 STOLT COMEY SEAWAY STONEBRIDGE LIFE INSURANCE STOUFFER PINEISLE RESORT STOWE ASSOCIATES ADMINISTRATORS 2977-00 3765-00 1861-00 2485-00 STRATEGIC HEALTH CARE STRATEGIC RESOURCE COMPANY STRAWBERRY ASSOCIATES LTD STUDENT ASSURANCE SERVICES, INC STUDENT INSURANCE DIVISION 2659-00 2626-00 2503-00 2980-00 1782-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 77 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP STUDENT INSURANCE INCORPORATED STUDENT PLANS INC SUBURBAN HEALTH CARE BENEFITS INC 1535-00 2096-00 2761-00 METAIRIE WHEATON FAIRFAX LA IL VA 70004 60189 22030 SUGAR CANE HEALTH CARE TRUST SUMMIT AMERICA INSURANCE 0755-00 3901-00 LAFAYETTE OVERLAND PARK LA KS 70598 66210 SUMMIT BANK INDPLS SUMMIT INSURANCE PLAN TRUST (GROUP PROG,INC) SUMMIT MEDICARE SUMMIT NATIONAL LIFE INS. 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SUNMARK EMPLOYEE BENEFIT TRUST 0444-00 1868-00 SHREVEPORT LITTLE ROCK LA AR 71130 72211 SUNSHINE OIL AND STORAGE INC SUPERIOR SURGICAL MANUFACTURING COMPANY 1362-00 2012-00 DONALDSONVILLE ST PETERSBURG LA PA 70346 33710 SUPERIOR VISION SUPERMARKET CLAIMS SUPERVALU INC SUPPLEMENTAL MEDICARE WRAPAROUND SUPPORT SYSTEMS INTERNATIONAL SUPREME LIFE INSURANCE SURE HEALTH INSURANCE BENEFITS SUSQUEHANNA ADMINISTRATORS INC SWIFT SHIPS SYCUAN INSURANCE SERVICES SYMETRA LIFE INSURANCE CO SYMETRA MEDICAL PLAN SYNESYS SYSCO GROUP BENEFIT PLAN 3254-00 1623-00 2525-00 3441-00 2062-00 1959-00 3403-00 1292-00 2486-00 2550-00 3278-00 3315-00 1715-00 1691-00 RACHO CORDOVA NEW ORLEANS HIGH POINT GOODLETTSVILLE CHARLESTON CHICAGO PLANTATION LANCASTER MORGAN CITY EL CAJON ASHLAND RICHARDSON ATLANTA HOUSTON CA LA NC TN SC IL FL PA LA CA WA TX GA TX 95741 70186 27261 37070 29402 60653 33318 17603 70381 92021 54806 75083 30337 77096 T K VALVE HEALTH PLAN T M L GROUP BENEFITS RISK POOL T P A OF PA T.I. 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TDI MANAGED CARE SERVICES INC (THRIFT DRUG INC) 1525-00 3670-00 2850-00 2838-00 P O BOX 546 P O BOX 1390 3987 UNIVERSITY DR SUITE 100 P O BOX 81189 7400 COLLGE BLVD SUITE 100 1 INDIANA SQ #B30 P O BOX 1180 P O BOX 7808 POST OFFICE BOX 5151 P O BOX 93098 ONE SUN LIFE EXECUTIVE PARK SUN LIFE BUILDING CHARLES CENTER 6001 FINANCIAL PLAZA ONE FINANCIAL CENTRE 650 SOUTH SHACKLEFORD RD P O DRAWER 72 5999 CENTRAL AVENUE STE 400 P O BOX 967 P O BOX 26099 P O BOX 10100 P O BOX 1449 P O BOX 97 3501 ML KING DR P O BOX 15398 P O BOX 1523 P O BOX 1908 P O BOX 21918 P O BOX 440 P O BOX 832237 4893 RIVERDALE RD SUITE 10103 FONDRAN SUITE 500 P O DRAWER 9248 P O BOX 2015 P O BOX 1127 P O BOX 655474 P O BOX 5508 KIRKLE-VAN ORSDEL INC 400 LOCUST ST 367 SOUTH GULPH ROAD CONTROL DATA POBOX 833823 DEPT 198 P O BOX 1459 P O BOX 22557 5304 FLORIDA BLVD P. O. 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FLOOD COMPANIES INC AMERICAN MILITARY SOCIETY INSURANCE PLANS AMERICAN WORKER BENEFIT GROUP BENEFITS FOUNDATION BRAND COMPANIES INC BUSINESSMEN'S & EMPLOYEES SECURITY TRUST CHAPMAN PRINTING CO., INC LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 79 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP THE DEACONESS HEALTH SERVICES CORP. 1565-00 ST LOUIS MO 63127 THE THE THE THE THE 1430-00 3635-00 1063-00 3884-00 1171-00 PENSION ASSOC INC 3701 S LINDBERGH P O BBOX 88572 P O BOX 8019 P O BOX 29164 P O BOX 165750 BENEFITS DEPT CALLER SERVICE 2264 GROUP EMPLOYEE BENEFIT FU P O BOX 1819 10E FIGUEROA ST P O BOX 924404 401 NORTH EXECUTIVE DR P O BOX2650 25145 COUNTRY CLUB BLVD 3616 SOUTH I10 SERVICE RD P O BOX 8570 111 VETERANS BLVD SUITE 500 10101 LINN STATION RD SUITE 870 P O BOX 83179 P O BOX 40 14111 SCOTTSLAWN AVE DEPT SM UNITED MED RESO P O BOX 145801 P O BOX 862 P O BOX 660145 P O BOX 850 FIRST CONTINENTAL INC CO P O BOX 3101 LEE JARMON FORD P O BOX 110098 2001 MARCUS AVE 100 NORTH 6TH SUITE 800 P O BOX 280 10235 W LITTLE YORK SUITE 430 P O BOX 152880 5434 W ST. 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ELM STREET P O BOX 13587 SALT LAKE CITY GARDEN CITY INGLEWOOD SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY LEXINGTON SALT LAKE CITY PHOENIX LATHAM KINGSTON SALT LAKE CITY DALLAS BRIDGEPORT METAIRIE UT NY CA UT UT UT UT KY UT AZ NY NY UT TX CT LA 84130 11530 90303 84130 84130 84131 84130 40512 84130 85013 12110 12402 84130 75380 06601 70002 MINNETONKA DALLAS CAMP SPRINGS MN TX MD 55343 75380 20746 CHICAGO IL 60601 BIRMINGHAM ALEXANDRIA OKLAHOMA CITY CINCINNATI CONCORD CEDAR RAPIDS OVERLAND PARK CINCINNATI AL LA OK OH NH IA KS OH 35202 71315 73154 45242 03301 52407 66213 45242 SALT LAKE CITY SALT LAKE CITY SAN ANTONIO CINCINATTI BATON ROUGE JACKSON PORTLAND BIG STONE GAP UT UT TX OH LA MS OR VA 84130 84130 78269 45250 70802 39205 97213 24219 DALLAS NATCHEZ OMAHA DELAWARE FEDERAL WAY TX MS NE OH WA 75261 39120 68131 43015 98003 NEW ORLEANS FT WORTH HINSDALE JACKSON LA TX IL MS 70123 76182 60521 39236 HEALTH INTEGRATED SERVICES HEALTH ONE HEALTH PLAN HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE (AZ PHYSICIANS) HEALTHCARE (MENTAL HEALTH) HEALTHCARE (RIVER VALLEY) HEALTHCARE DENTAL CLAIMS HEALTHCARE INSURANCE CO HEALTHCARE OF EXFORD HEALTHCARE OF LOUISIANA UNITED HEALTHCARE SRVCS/AFFILIATES UNITED HEALTHCARE STUDENT RESOURCES UNITED INDUSTRIAL WORKERS OF NORTH AMERICA 3559-00 3909-00 1658-00 UNITED INS CO OF AMERICA 0516-01 UNITED UNITED UNITED UNITED UNITED UNITED UNITED UNITED INS. CO. OF AMERICA INSURANCE CO INSURANCE COMPANIES INC LIBERTY LIFE INS. CO. LIFE AND ACCIDENT INS. CO. LIFE INSURANCE COMPANY LIFE INSURANCE COMPANY MEDICAL RESOURCES 0516-00 1734-00 2181-00 0478-00 0479-00 1827-00 2914-00 3352-00 UNITED UNITED UNITED UNITED UNITED UNITED UNITED UNITED MEDICAL RESOURCES MEDICAL RESOURCES MEDICAL RESOURCES MEDICAL RESOURCES METHODIST CHURCH (SELF-INSURED) METHODIST CHURCH OF MS. MIDDLE TRADES ASSOCIATION MINE WORKERS OF AMERICA 3794-00 3990-00 3574-00 1805-00 1212-00 1712-00 3367-00 1765-00 UNITED UNITED UNITED UNITED UNITED MINE WORKERS OF AMERICA NATIONAL LIFE INS OF OMAHA LIFE INS. CO. OLYMPIC LIFE INS. CO. PACIFIC LIFE INS. CO. H900-91 1893-00 0480-00 1499-00 0481-00 UNITED UNITED UNITED UNITED PARCEL SERVICES PROVIDER SERVICES SAVINGS LIFE INS. CO. SECURITY LIFE INSURANCE COMPANY 1090-00 3155-00 0482-00 2580-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 85 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY UNITED SERVICE ASSN FOR HEALTHCARE UNITED SERVICE ASSOCIATION FOR HEALTH CARE 3866-00 1545-00 MISSION VIEJO CA DALLAS/FT WORTH ARPT TX 92690 75261 UNITED UNITED UNITED UNITED UNITED UNITED UNITED UNITED UNITED UNITED 1241-00 1245-00 2052-00 0483-00 1396-00 3691-00 1599-00 2897-00 0983-00 0484-00 P O BOX 6080-174 NATIONAL HEALTH CARE INS POST OFFICE BOX 619999 P O DRAWER 66398 P O BOX 1186 P O BOX 152152 125 MAIDEN LANE 600 GRANT STREET P O BOX 30010 P O BOX 26580 14600 DETROIT AVE NATIONAL EXECUTIVE OFFICE ADMINISTRATIVE & SERVICE DODGE AT 33RD 7800 MADISON ST 3316 FARNAM ST P O BOX 30783 840 CAROLINA ST P O BOX 39550 P O BOX 3509 1600 E HILL ST P O BOX 700 367 SOUTH GULPH ROAD P O BOX 3211 100 CENTRAL AV SUITE 200 P O BOX 294 480 LINDEN AT WELLINGTON P O BOX 5077 5115 OAK STREET 600 JONESBORO ST FLEXIBLE BENEFITS SERVICE 2211 CONGRESS STREET FLEXIBLE BENEFITS SERVICE 2211 CONGRESS STREET P O BOX 2997 PITTSBURGH P O BOX 2999 P O BOX 6589 P O BOX 1650 P O BOX 30654 TERMINAL ANNEX 8550 UNITED PLAZA BLVD STE 805 P O BOX 14172 P O BOX 924708 P O BOX 152152 P O BOX 527750 P O BOX 6080-288 7301 N 16 STREET/STE 201 P O BOX 449 BATON ROUGE METAIRIE IRVING NEW YORK PITTSBURGH AUSTIN AUSTIN CLEVELAND TREVOSE OMAHA LA LA TX NY PA TX TX OH PA NE 70896 70004 75015 10038 15219 78755 78755 44107 19049 68175 RIVER FOREST OMAHA SALT LAKE CITY SAUK CITY ROCHESTER ORLANDO SIGNAL HILL DUNCAN KING OF PRUSSIA ST PETERSBURG ST PETERSBURG IL NE UT WI NY FL CA OK PA FL FL 60305 68175 84130 53583 14604 32802 90755 73533 19406 33731 33701 ST PETERSBURG MEMPHIS SOUTHFIELD KANSAS CITY RUSTON PORTLAND FL TN MI MO LA ME 33731 38105 48086 64112 71273 04122 PORTLAND ME 04122 PA 15230 PITTSBURGH SYRACUSE LITTLE ROCK LOS ANGELES PA NY AR CA 15230 13217 72203 90030 BATON ROUGE LA 70809 WASHINGTON HOUSTON IRVING MIAMI MISSION VIEJO PHOENIX VAN BUREN DC TX TX FL CA AZ AR 20044 77292 75015 33152 92690 85020 72956 SOUTHERN UNDERWRITERS STATES FIDELITY & GUARANTY CO STATES GUARDIAN HEALTH INSURANCE CO STATES LIFE INS. CO. IN THE CITY OF NY, THE STATES STEEL AND CARNEGIE FUND TEACHERS ASSOC INS COMPANY TEACHERS ASSOC. INS. COMPANY TRANSPORTATION UNION INSURANCE ASSOCIATION VETERAN'S INSURANCE COMPANY WORLD INS. CO. UNITED WORLD LIFE INSURANCE COMPANY UNITED WORLD LIFE INSURANCE COMPANY UNITEDHEALTH INTEGRATED SERVICES UNITY HEALTH INSURANCE UNIVERA UNIVERSAL AMERICAN UNIVERSAL CARE INC UNIVERSAL FIDELITY INS. UNIVERSAL HEALTH SERVICES INC UNIVERSAL HEALTHCARE UNIVERSAL HEALTHCARE 0764-00 3783-00 3873-00 3301-00 3374-00 H333-30 3381-00 0853-00 1548-00 H582-00 H540-40 UNIVERSAL HEALTHCARE UNIVERSAL LIFE INS. CO. UNIVERSAL STANDARD HEALTH CARE UNIVERSAL UNDERWRITERS LIFE INS. CO., THE UNR HOME PRODUCTS (SELF-INSURED) UNUM LIFE INSURANCE CO OF AMERICA 3730-00 0485-00 2942-00 0486-00 2414-00 0467-00 UNUM MUTUAL LIFE INS. CO. 0466-00 UPMC HEALTH PLAN H390-70 UPMC HEALTH PLAN UPSTATE ADMIN SERVICES US ABLE LIFE US ADMINISTRATORS 3962-00 2886-00 2201-00 0749-00 US AGENCIES CASUALTY INSURANCE CO 3304-00 US CIVIL SERVICE COMMISSION BUREAU/RETIREMENT US FAMILY HEALTH PLAN US GUARDIAN HEALTH INS CO USA AMERICAN USA HEALTHCARE USA HEALTHNET INC / FORMERLY AMER.HLTH.NETWORK INC USA TRUCK,INC 0715-00 3967-00 1784-00 1982-00 3970-00 1278-00 2351-00 ST ZIP LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 86 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP USAA LIFE INS. CO. USI ADMINISTRATORS/CBCA ADMINISTRATORS USL CAMPUS INSURANCE USLIFE CREDIT LIFE INS. CO. USNOW UTAH LABORERS HEALTH & WELFARE FUND UTC (A FRATERNAL BENEFIT SOCIETY) V.I.P. NATIONAL AUTOMOTIVE INS 0458-00 3030-00 2207-00 0459-00 3353-00 3214-00 2852-00 1984-00 SAN ANTONIO SAVANNAH LAFAYETTE SCHAUMBURG PLANO SALT LAKE CITY COLUMBUS DALLAS TX GA LA IL TX UT OH TX 78288 31416 70504 60195 75026 84119 43215 75235 VALERO CORPORATE SERVICES COMPANY VALLEY FORGE LIFE INS. CO. VALLEY LINE COMPANY (SEQUA) VALLEY SYSTEMS MEDICAL ASSISTANCE PROGRAMS VALUE BEHAVIORAL HOUSE VALUE OPTIONS VALUE RX 3069-00 0487-00 1918-00 2044-00 2522-00 3163-00 2142-00 SAN ANTONIO CHICAGO ST LOUIS COLUMBIA TAMPA LATHAM SOUTHFIELD TX IL MO MD FL NY MI 78292 60685 63105 21045 33607 12110 48075 VANTAGE HEALTH PLAN INC VANTAGE HEALTH PLAN, INC. VARIABLE PROTECTION ADMINISTRATORS INC VERITY HEALTHNET VERMILION PARISH SHERIFF DEPART. HEALTH BENEFIT PLAN VERNON PARISH SCHOOL BOARD VETERANS ADMINISTRATION VETERANS ADMINISTRATION/CHAMPVA VETERANS LIFE INS. CO. VETERANS OF FOREIGN WARS VETRI SYSTEMS VICARE ADMINISTRATIVE SERVICES VISION INS. CO. VISION SERVICE PLAN VISTA MANAGEMENT VIVA HEALTH ADMINISTRATION VIVIAN INDUSTRIAL PLASTICS(SELF-INSURED) VOLUNTARY BENEFITS INC VOLUNTEER CAPITAL CORPORATION VOLUNTEER STATE LIFE INS. CO. VOYAGER LIFE INS. CO. VRX PHARMACY SERVICES VULCAN LIFE INS. CO. VYTRA HEALTHCARE MANAGED SYSTEMS INC W E WALKER STRESS INC W.J. JONES ADMINISTRATIVE SERVICES WABASH LIFE INS. CO. WACKENHUT CORPORATION (SELF INSURED) WAFFLE HOUSE PLAN WAGGONERS TRUCKING WAL MART BENEFITS 2804-00 H557-60 2146-00 3307-00 1797-00 2242-00 3621-00 0700-00 0488-00 1462-00 3212-00 3168-00 2862-00 3494-00 1934-00 3592-00 1301-00 2884-00 2095-00 0489-00 0490-00 3889-00 0491-00 2944-00 1253-00 2744-00 0492-00 1311-00 1526-00 3324-00 0707-00 MONROE MONROE CLEVELAND BATON ROUGE ABBEVILLE LEESVILLE FLOWOOD NEW ORLEANS FRAZER KANSAS TROY SUFFOLK SACRAMENTO RANCHO CORDOVA TALLAHASSEE BIRMINGHAM VIVIAN BIRMINGHAM NASHVILLE CHATTANOOGA JACKSONVILLE SALT LAKE CITY BIRMINGHAM MELVILLE JACKSON LAKE SUCCESS INDIANAPOLIS CORAL GABLES NORCROSS BILLING ROGERS LA LA OH LA LA LA MS LA PA MO MI VA CA CA FL AL LA AL TN TN FL UT AL NY MS NY IN FL GA MT AR 71201 71201 44130 70884 70510 71446 39232 70146 19355 64111 48007 23434 95899 95670 32312 35255 71082 35283 37202 37402 32203 84109 35201 11747 39206 11042 46260 33146 30071 59104 72756 WALGREEN INSURANCE COMPANY WALKER BENEVOLENT SOCIETY 1207-00 1696-00 USAA BUILDING P O BOX 16579 P O BOX 42611 ONE WOODFIELD LAKE P O BOX 260808 2156 WEST 2200 SOUTH P O BOX 159019 DALLAS REG CLIMS OFFICE P O BOX 36128 P O BOX 500 CNA PLAZA 120 SOUTH CENTRAL AVE P O BOX 338 1715 NORTH WEST SHORE 775 P O BOX 1347 22255 GREENFIELD SUITE 550 130 DESIARD ST/STE 300 130 DESIARD ST., STE 300 6902 PEARL ROAD-SUITE 500 P O BOX 83578 P O BOX 307 201 BELVIEW ST 16 CONSOLIDATED FEE 1601 PERDIDO ST LIBERTY PARK BROADWAY AT 34TH STREET P O BOX 5028 1000 COMMERCIAL LANE P O BOX 997100 3333 QUALITY DR 2424 ALLEN RD P O BOX 55926 P O BOX 232 P O BOX 830626 P O BOX 24300 VOLUNTEER STATE LIFE BLDG POST OFFICE BOX 2918 P O BOX 9780 POST OFFICE BOX 1886 395 NORTH SERVICE ROAD P O BOX 9407 1979 MARCUS AVE 8935 N MERIDIAN ST 1500 SAN REMO AVENUE P O BOX 6450 P O BOX 21367 922 W. WALNUT ST SUITE A P O BOX 4007 P O BOX 45 DANVILLE WALKER IL LA 61834 70785 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 87 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP WAREHOUSE LOCAL 570 WASHINGTON LIFE INS. CO. OF AMERICA WASHINGTON NATIONAL INS. CO. WASHINGTON NATIONAL INSURANCE CO WASHINGTON NATIONAL LIFE 2527-00 0493-00 0519-00 0519-01 1076-00 BALTIMORE LAFAYETTE CARMEL CARMELON ABBEVILLE MD LA IN IN LA 21226 70501 46032 46032 70510 WASHINGTON TEAMSTERS WELFARE TRUST WASHINGTON-IDAHO CARPENTERS HEALTH WASTE MANAGEMENT INC WASTE MANAGEMENT OF B.R. WASTE MANAGEMENT OF ST.TAMMANY WATCO EMPLOYEE HEALTH CARE PLAN WATERSTONE BENEFIT ADMINISTRATOR 2613-00 3488-00 1689-00 2373-00 2005-00 2480-00 3736-00 SEATTLE SPOKANE MONROE BATON ROUGE SLIDELL SHAWNEE MISSION WA WA LA LA LA KS OK 98102 99205 71202 70835 70469 66207 73116 WATKINS ASSOCIATED INDUSTRIES INC WAUSAU UNDERWRITERS INS CO WEA INSURANCE GROUP(WISCONSIN EDUCATION ASSOC) WEB TPA WEDGE ENERGY GROUP WEDGE WIRELINE INC WEHCO MEDIA GROUP BENEFITS WELBORN HMO WELL POINT HEALTH NETWORKS INC WELL TECH. INC WELLCARE WELLCARE WELLCARE WELLCARE WELLCARE WELLCARE HEALTH INS. OF ARIZONA WELLCARE HEALTH PLANS WELLCARE OF LA WELLPOINT NEXT RX WELLS FARGO WELLSTAR HEALTH SYSTEM WEMBLEY INDUSTRIES INC WEMCO INC WEST CAL. CAMERON HOSPITAL WEST FELICIANA SCHOOL DIST WEST JEFFERSON HOSPITAL (SELF-INSURED) WEST LAKE GROUP EMPLOYEE HEALTH CARE PLAN 3257-00 0989-00 3025-00 3543-00 2412-00 2212-00 2221-00 2479-00 2868-00 1927-00 3586-00 3599-00 H103-20 H190-30 H649-90 H134-00 3587-00 3283-00 3603-00 3530-00 3008-00 0931-00 1624-00 2341-00 1417-00 2728-00 2453-00 ATLANTA WAUSAU MADISON GRAPEVINE HOUSTON GRAND PRARIE LITTLE ROCK EVANSVILLE WOODLAND HILLS HOUSTON SCRANTON SCRANTON TAMPA TAMPA SCRANTON TAMPA TAMPA TAMPA CINCINNATI CHARLESTON LONDON NEW ORLEANS NEW ORLEANS SULPHUR SHREVEPORT MARRERO COLUMBUS GA WI WI TX TX TX AR IN CA TX PA PA FL FL PA FL FL FL OH WV KY LA LA LA LA LA OH 30301 54401 53707 76099 77219 75054 72221 47712 91365 77002 18505 18505 33631 33622 18505 33634 33622 33631 45240 25322 40742 70125 70151 70664 71135 70072 43216 WEST STATES INS. CO. WESTERN AMERICAN LIFE INSURANCE CO. WESTERN AND SOUTHERN LIFE INS. CO., THE WESTERN ATLAS INTERNATIONAL,INC WESTERN CASUALTY LIFE INSURANCE COMPANY WESTERN CATHOLIC UNION 0499-00 1054-00 0497-00 1355-00 1342-00 1040-00 PHOENIX RICHARDSON CINCINNATI HOUSTON ARLINGTON QUINCY AZ TX OH TX TX IL 85016 75083 45202 77252 76011 62301 WESTERN FARM BUREAU WESTERN FIDELITY 1597-00 0863-00 4200 PENNINGTON AVE POST OFFICE BOX 3468 11815 N PENNSYLVANIA 11815 N PENNSYLVANIA VERMILION PARISH SHERIFF P O BOX 307 2323 E LAKE AVE EAST P O BOX 5434 284 WAGON WHEEL RD P O BOX 40318 P O BOX 6330 P O BOX 7965 4013 NW EXPRESSWAY OKLAHOMA CITY P O BOX 1738 811 NO 1ST AVE P O BOX 7338 P O BOX 99906 P O BOX 130688 P O BOX 540069 P O BOX 8200 346 N REDBANK RD P O BOX 4204 1000 LOUISIANA SUITE 2600 P O BOX 4438 P O BOX 4438 P O BOX 31372 P O BOX 25913 P O BOX 4438 8735 HENDERSON RD #2 P O BOX 25237 P O BOX 31370 P O BOX 145433 P O BOX 608 P O BOX 7711 966 S WHITE ST P O BOX 51119 P O BOX 2269 P O BOX 51005 1101 MEDICAL CENTER BLVD HARRINGTON BENEFITS SER P O BOX 16789 4808 NORTH 22ND STREET P O BOX 832687 400 BROADWAY P O BOX 2469 1112 COPELAND ROAD 906 WCU BLDG 510 MAINE ST 206 BLACKWELL BOX 584 1112 COPELAND ROAD BLACKWELL ARLINGTON OK TX 74631 76011 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 88 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP WESTERN WESTERN WESTERN WESTERN WESTERN 0494-00 1390-00 3541-00 1447-00 1718-00 POST OFFICE BOX 1660 39 SOUTH LASALLE/STE 425 2315 STOCKTON BLVD P O BOX 901010 4200 SOUTH I10 SERVICE RD WEST, STE 134 POST OFFICE BOX 43271 C/0 AMERICAN BENEFIT PLAN 2715 MACKEY STE 207 6601 CENTERVILLE BUSINESS PARK P O BOX 40018 POST OFFICE BOX 2667 P O BOX 8082 POST OFFICE BOX 2907 HUMAN RESOURCES DEPT DROP2-9 ONE LAKE STREET P O BOX 1413 1006 LIGONIER ST P O BOX 889 9201 WATSON AVE STE 100 P O BOX 30132 P O BOX 91059 P O BOX 9329 228 ST CHARLES AVE 639 LOYOLA AVE SUITE 1320 100 SECOND AVE S/FLOOR 11 2112 W JEFFERSON ST P O BOX 1439 P O BOX 1100 P O BOX 770466 P O BOX 1779 P O BOX 305154 P O BOX 305154 P O BOX 2906 EMPLOYEE BENEFIT TRUST 2600 GREENWOOD RD 1 SOUTH CALVERT ST 4545 N LINCOLN BLVD P O BOX 269003 7100 COMMERCE WAY SUITE 285 P O BOX 51059 7100 COMMENCE WAY SUITE 285 2140 MIDWAY AVE HEALTH & WELFARE PLAN 2802 COHO ST/STE 201 P O BOX 981 HOUSTON CHICAGO SACRAMENTO FORT WORTH METAIRIE TX IL CA TX LA 77001 60603 95817 76101 70001 ST. PAUL SHREVEPORT MN LA 55164 71118 CENTERVILLE OH 45459 FRESNO PHOENIX FRESNO FARGO UPPER SADDLE RIVER CA AZ CA ND NJ 93755 85002 93749 58102 07458 DUNCAN LATROBE OK PA 73534 15650 ST LOUIS MO 63126 LANSING SEATTLE SHREVEPORT NEW ORLEANS NEW ORLEANS MI WA LA LA LA 48909 98111 71139 70130 70113 ST PETERSBURG JOLIET HENDERSONVILLE RUSTON OKLAHOMA CITY FORT WORTH NASHVILLE NASHVILLE WICHITA SHREVEPORT FL IL TN LA OK TX TN TN KS LA 33701 60435 37077 71270 73177 76101 37230 37230 67201 71130 BALTIMORE OKLAHOMA CITY PLANO BRENTWOOD MD OK TX TN 21202 73105 75026 37027 NEW ORLEANS BRENTWOOD LA TN 70151 37027 SHREVEPORT MADISON LA WI 71108 53713 BROOKFIELD WI 53008 GENERAL LIFE INS. CO. GENERAL SERVICES HEALTH ADVANTAGE INSURANCE COMPANIES LA. LABORERS KELLY & ASSOCIATES INC WESTERN LIFE INS. CO. WESTERN LOUISIANA LABORS HEALTH & WELFARE 0495-00 0703-00 WESTERN OHIO HEALTH CARE PLAN 2326-00 WESTERN WESTERN WESTERN WESTERN WESTERN 1652-00 0496-00 0977-00 0498-00 0823-00 PLAN SERVICES SECURITY LIFE INS. CO. STATES ADMINISTRATORS STATES LIFE INS. CO. UNION WESTLAKE GROUP OF COMPANIES WESTMORELAND CASUALTY COMPANY 3132-00 0849-00 WESTPORT BENEFITS 2961-00 WEY CO INC WEYERHAEUSER COMPANY WHITE CONSOLIDATED INDUSTRIES WHITNEY NATIONAL BANK WHITTAKER HEALTH SERVICE 3081-00 2491-00 2131-00 1647-00 0858-00 WHP WILL CNTY & VICINITY DIST COUNCIL OF CARPENTERS WILLAIM C BEELER & COMPANY WILLAMETTE INDUSTRIES INC WILLBROS GROUP MEDICAL PLAN WILLIAMSON DICKIE MANUFACTURING CO (SELF-INSURED) WILLIS ADMINISTRATIVE SERVICES WILLIS CORROON ADMINISTRATIVE SERVICES WILLIS CORROON CORP OF KANSAS WILLIS KNIGHTEN HEALTH PLAN 1377-00 0898-00 3080-00 1547-00 3015-00 2757-00 3063-00 2963-00 2807-00 1282-00 WILLSE & ASSOCIATES INC WILSON FOODS WINDSOR STERLING WINDSOR-MEDICARE EXTRA HMO 1493-00 0936-00 H341-00 3549-00 WINN DIXIE LA INC WINSOR EXTRA 1379-00 H185-00 WINWARD INSTITUTE INC WISCONSIN ELECTRICAL EMPLOYEES 2872-00 3151-00 WISCONSIN EVANGELICA LUTHERAN SYNOD 3183-00 LAM1R032 RUN: 01/31/15 15:47:13 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEMS DEPARTMENT OF HEALTH AND HOSPITALS - MEDICAL ASSISTANCE PROGRAM TP-0-32-2 PAGE: 89 TPL CARRIER FILE LISTING CARRIER NAME CARRIER CODE CARRIER ADDRESS-LINE 1 CARRIER ADDRESS-LINE 2 CITY ST ZIP WISCONSIN LABORER'S HEALTH FUND 3273-00 DEFOREST WI 53532 WISCONSIN PHYSICIANS SERVICE WITCO MEDICAL BENEFIT PLAN WITTNER COMPANIES WMU HEALTH AND WELFARE FUND WOODMEN OF THE WORLD WOODMEN OF THE WORLD 1896-00 1349-00 2433-00 2514-00 3908-00 0852-00 MADISON GRETNA ST. PETERSBURG SAVANNAH OMAHA OMAHA WI LA FL GA NE NE 53708 70054 33710 31403 68103 68102 WOODSMALL BENEFITS SERVICES INC WORCESTER HEALTH CLAIMS WORLD ACCESS CANADA,INC WORLD HEALTH FOUNDATION & TRUST 1811-00 2122-00 2929-00 1532-00 JOPLIN WORCESTER WATERLOO BATON ROUGE MO MA ON LA 64803 01605 00000 70895 WORLD INS. CO. WORLD SERVICE LIFE INS. CO. WORLD SERVICE LIFE INS. CO. OF CO WORLDWID INSURANCE/CLAIM SERVICE WPAS NW PLUMBERS TRUST YEARGIN INC YOUNG BUSINESS PEOPLE OF AMERICA 0500-00 0501-00 0502-00 2010-00 3946-00 1611-00 1327-00 OMAHA DENVER FORTH WORTH SPRINGFIELD SEATTLE GREENVILLE WINSTON SALEM NE CO TX MO WA SC NC 68101 80222 76101 65804 98124 29606 27116 ZALE CORPORATION ZAPATA GULF MARINE CORPORATION HEALTH PLAN ZAPATA PROTEIN CORP ZEBA TRUST CLAIMS (LAYRE CORP) ZENITH ADMINISTRATORS (LABRS OF MT) 1663-00 1687-00 1970-00 1238-00 3727-00 IRVING HOUSTON ABBEVILLE HAMPTON SPOKANE TX TX LA NH WA 75038 77227 70511 03842 99201 ZENITH ADMINISTRATORS INC 2283-00 DALLAS TX 75214 ZURICH AMERICAN LIFE INS. CO. 0503-00 4633 LIUNA WAY STE 201 P O BOX 8934 P O BOX 308 5999 CENTRAL AVE/STE 400 P O BOX 23679 P O BOX 2397 WOODMEN TOWER 1700 FARNAM STREET P O BOX 2547 440 LINCOLN ST P O BOX 516 P O BOX 35212 SUITE 282 WORLD INSURANCE BLDG. POST OFFICE BOX 22293 POST OFFICE BOX 1876 2274 E SUNSHINE P O BOX 34687 P O BOX 6508 P O BOX 11107 7996 NORTH POINT BLVD 905 W WALNUT HILL LANE P O BOX 27718 P O BOX 369 DRAWER 6000 111 WEST CATALDO AV STE 220 6162 EAST MOCKINGBIRD SUITE 207 231 N. MARTINGALE ROAD THE ZURICH BUILDING SCHAUMBURG IL 60196 TOTAL CARRIERS ON FILE :3,911
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