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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.
Calendar
Title and navigation
Title and navigation
<<
<
September, 2023
>
<<
September, 2023
S
M
T
W
T
F
S
35
27
28
29
30
31
1
2
36
3
4
5
6
7
8
9
37
10
11
12
13
14
15
16
38
17
18
19
20
21
22
23
39
24
25
26
27
28
29
30
40
1
2
3
4
5
6
7
(MM/DD/YYYY)
Date of Service
*
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
<<
<
September, 2023
>
<<
September, 2023
S
M
T
W
T
F
S
35
27
28
29
30
31
1
2
36
3
4
5
6
7
8
9
37
10
11
12
13
14
15
16
38
17
18
19
20
21
22
23
39
24
25
26
27
28
29
30
40
1
2
3
4
5
6
7
(MM/DD/YYYY)
Claim Number
- OR -
Patient Account Number
Amount Billed
*
You must fill out all fields on this form for EOBs.
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