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Need a release form? Use this one if you don't have your own.

claimshistorywaiver

CRICO Contact Options

Credentialing/Third Party Administrator Proof of Insurance Request

Our Underwriting department is here to assist you.

Please complete this form. * = required field

Confirmation of Insurance Requests

Not sure? Check this list of CRICO-insured institutions.

Delivery & Support Information

To send to another person, enter the email address and name in "Note to Underwriting" below.

Requirements for Proof of Insurance Requests

Degree not on list?
Enter yours here.

Mass General Brigham does not directly employ clinicians.

Please provide a release form if you are not affiliated with the clinician's CRICO-insured employer.

Confirmation and Follow-Up

By checking the box, you are confirming that you are authorized to access the proof of insurance document(s) for the above provider(s).

Optional