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LOUISIANA MEDICAID PROGRAM ISSUED: 06/01/11 …
www.lamedicaid.comCHAPTER 1: GENERAL INFORMATION AND ADMINISTRATION SECTION 1.4: GENERAL CLAIMS FILING PAGE(S) 21 Page 3 of 21 Section 1.4 General Reminders With the exception of the UB04 claim form, all other claim forms must be signed and dated. The FI …