Provider Services


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


Provider EIN/TIN *
Participant SSN *
Patient SSN *
Patient Date of Birth *
RadDatePicker
RadDatePicker
Open the calendar popup.
(MM/DD/YYYY)
Date of Service *
RadDatePicker
RadDatePicker
Open the calendar popup.
(MM/DD/YYYY)



Claim Number - OR - Patient Account Number
Amount Billed *

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

ACS
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