A MORE DETAILED NOTICE, INCLUDING A SAMPLE CLAIM FORM INDICATING THE APPROPRIATE PLACEMENT OF THE REQUIRED TPL CARRIER CODE AND PAYMENT AMOUNT CAN BE FOUND ON OUR WEB SITE, WWW.LAMEDICAID.COM <HTTP://WWW.LAMEDICAID.COM/>, LINK NEW MEDICAID INFORMATION, AFTER WHICH IT WILL BE MOVED TO THE ...
TO ENSURE PROPER HANDLING OF THE REQUESTS FOR PRIOR AUTHORIZATION FOR SERVICES COVERED IN THE EXPANDED DENTAL SERVICES FOR PREGNANT WOMEN (EDSPW) PROGRAM, WE ASK THAT THE BHSF FORM 9-M BE PLACED ON TOP OF THE ADA CLAIM FORM AND OTHER DOCUMENTS (I.E., RADIOGRAPHS) FOR EACH PRIOR AUTHORIZA...