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Member ID 9999 Patient 7 67 1 0 Claim Account Service Date Amt. Paid Paid Date 2013000ZZ0000 1/24/2013 114. SAMPLE 000602/1369 AGR79N D S1-ET-M1-C001 603 1 PLEASE RETURN COUPON WITH YOUR PAYMENT - DO NOT STAPLE Processing System WG ACR Letter ID 9999999 Request Amount 10. Thank you for your attention to this matter. Toll Free 8667912292 ext. Letter ID 9999999 In Wisconsin Blue Cross Blue Shield of Wisconsin BCBSWi underwrites or administers the PPO and indemnity policies Compcare Health...
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PO Box 105557 is a specific P.O. Box address used for mailing purposes.
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