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Credentialing & Claims History

  • Personal Requests

    If you would like to request credentialing or a claims history, please complete the authorized release form that can be downloaded below and provide the following information with your request:

    • Policy number
    • Signed release with date
    • An email or fax number of where to send the completed request.

  • Administration Requests

    If you are a third party organization looking to verify information and/or claims, please send your release and request to: [email protected].

    Requests must include the following:

    • Policy number
    • A release signed within the past 6 months
    • An email or fax number of where to send the completed request.

Send Your Credentialing Requests

Send your credentialing requests by email to: [email protected]. If your practice does not currently have a release form, click here to download a sample form.

Download Form

Contact our offices if you have not received a response to your request within 48 business hours. Our commitment is to provide responses to requests within 2 business days. You can inquire about your request at [email protected].