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Document Upload Portal for Providers
Note to Providers: If you have received an Explanation of Benefits (EOB) for an ISO Member,
please complete the information below and upload the needed information via this
SECURE
portal.
1. Member last name:
*
Member first name:
*
2. Insurance ID# (nine digit number):
*
3. Group number:
*
4. Claim Number (as shown on EOB):
5. Provider name:
*
6. Provider TIN:
*
7. Types of documents being uploaded:
*
8. Upload documents here.
*
HealthSmart
PO Box 94468| Lubbock, TX 79493-4468 | 800-203-4720 (tel) |806.473.3136 (fax)