Scope of CoverageDescriptionNotes
01Major Medical
02Medicare Supplement
10Inpatient Hospital Only
12Outpatient Hospital Only
16Physician Only
18Dental Only
19Drugs Only
20Nursing Home Only
21Cancer Only
22CHAMPUS/CHAMPVA
23Veterans Administration
25HMO
27Major Medical without Maternity BenefitsNot to be sent on TPL Submission Files
Must submit a “Louisiana Department of Health – Medicaid Recipient Insurance Information Update” form to latpr@gainwelltechnologies.com"
30Medicare HMO (Part C)
34Vision OnlyNew as of 11/11/2024
35LTC OnlyNew as of 11/11/2024
36Mental Health OnlyNew as of 11/11/2024
SESupport Enforcement

Retired SOC Below:

Scope of CoverageDescriptionNotes
00Not AvailableRetired as of 11/11/2024
03Hospital, Physician, Dental and DrugsRetired as of 11/11/2024
04Hospital, Physician, DentalRetired as of 11/11/2024
05Hospital, Physician, DrugsRetired as of 11/11/2024
06Hospital, PhysicianRetired as of 11/11/2024
07Hospital, Dental and DrugsRetired as of 11/11/2024
08Hospital, DentalRetired as of 11/11/2024
09Hospital, DrugsRetired as of 11/11/2024
11Inpatient Hospital OnlyRetired as of 11/11/2024
13Physician, Dental and DrugsRetired as of 11/11/2024
14Physician and DentalRetired as of 11/11/2024
15Physician and DrugsRetired as of 11/11/2024
17Dental and Drugs OnlyRetired as of 11/11/2024
24TransportationRetired as of 11/11/2024
26Carrier declared BankruptcyRetired as of 11/11/2024
28HMO/Insurance Premium Paid by Medicaid GHIPP ProgramRetired as of 11/11/2024
29Skilled Nursing CareRetired as of 11/11/2024
31Physician Only HMORetired as of 11/11/2024
32Pharmacy (PBM)Retired as of 11/11/2024
33HMO No MaternityRetired as of 11/11/2024