Credentialing: Request Proof of Insurance or Loss Runs
Please complete the form below to submit a credentialing request. All credentialing requests require a signed authorization form from the provider prior to releasing their claims history report. Requests are processed in the order that they are received. More complete information will expedite the process.
Please note: If you have submitted a credentialing request in the past, the email address for our credentialing department has changed to firstname.lastname@example.org
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