BAMS - Administered by ACS

Dear Providers, this lookup is for the members of UFCW Local 1529 only.

Provider EIN/TIN *

Participant SSN *

Patient SSN *

Patient Date of Birth *

(MM/DD/YYYY)

Date of Service *

(MM/DD/YYYY)

Claim Number

- OR - Patient Account Number

Amount Billed *

You must fill out all fields on this form for EOBs.