Credentialing/Third Party Administrator Proof of Insurance Request

Our Underwriting department is here to assist you.

For 3rd-party credentialers or admins.

Confirmation of Insurance Requests

I work for a CRICO member organization * Yes No

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

Delivery & Support Information

Requester Name *

Requester Email *

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

Requester Organization *

Other *

Requester Organization *

Requirements for Proof of Insurance Requests

Clinician First Name *

Clinician Last Name *

Clinician Title *

Clinician Title Other * Degree not on list?
Enter yours here.

Clinician's CRICO-insured Employer *

Mass General Brigham does not directly employ clinicians.

Employer Address *

City *

State *

ZIP Code *

Do you need proof of insurance for the current year, all years of employment, or other? *

Other

Clinician Signed Release Form

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

Confirmation and Follow-Up

I acknowledge this statement to be true. *

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

Note to Underwriting

Optional

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

Can’t Reach Us? Assistance for CRICO members with urgent questions or needs may be obtained through the on-call risk manager at your institution.

Claims/Suits: Contact the Claim Manager responsible for your institution or the Senior Vice President of Claims.

Confirmation of Coverage /Facesheets: CRICO-insured physicians needing access to your Confirmation of Coverage (Facesheet), log into your Physician Portal, or email our Underwriting staff or 617.450.8219.

CME Questions: Email Maggie Janes or call 617.4506828.

Media Requests: Email Missy Padoll or call 617.450.6841.

Other Inquiries: To reach someone at CRICO, call 617.450.5500. If you are a physician, identify yourself as such and the organization with which you are affiliated. You will be connected to the CRICO representative responsible for your organization.

Confirmation of Insurance Requests

Delivery & Support Information

Requirements for Proof of Insurance Requests

Confirmation and Follow-Up

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

About CRICO

CME Opportunities

Patient Safety & Claims