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Clinician Claim History Request

Our Underwriting department is here to assist you.

Please complete this form. * = required field

Requirements for Claims History Requests

Mass General Brigham does not directly employ clinicians. Please be more specific.

There is a $25 fee for your request. Click this link to submit payment to PayPal. The link will also appear upon submitting this form.

Optional: if you need CRICO to fill out a particular form, you can upload that here.

Confirmation and Follow-Up

By checking the box, you are confirming that you are the current CRICO-insured provider. Further, you acknowledge that you have verified the recipient email address above.