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Click ‘Get Form’ to open it in the editor.
Begin by entering your facility information. Fill in the 'Facility Name', 'Street Address', 'City', 'State', and 'Zip Code' fields accurately.
Next, provide details about your insurance carrier. Complete the 'Insurance Carrier' section with the name, street address, and policy number.
In the designated area, ensure you include a detailed summary of all claims related to behavioral health or substance abuse treatment. If no claims have been filed, add a statement confirming this.
Sign the form in the 'Authorized Signature' section and date it appropriately. Make sure to print your name, title, and phone number for clarity.
Once completed, forward the form to your insurance carrier via email or fax as indicated.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

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How to provide proof of claims history?

This could be an email or letter containing proof of your claims history from your previous insurer, such as a renewal invitation, schedule, or statement of insurance/fact. Please be advised we dont accept No Claims Discount as proof of your claims history.

How do I request claims history from the doctors company?

Where do I submit a request for a Loss Run or Claims History report? Credentialing requests can be sent to memberservices@thedoctors.com or faxed to (707) 265-3466. Claims History reports can be generated on-demand via the Agent/Broker Portal.

How to get a claims history?

Contact your insurance provider Your insurance provider should hold a record of your claim history, including any claims made under your current policy as well as any previous claims declared when you took out your policy. They can give you details of dates, type of claims, how much was paid out and any injuries.

How to see insurance claim history?

One is to ask your previous or current insurer for a letter of experience, which shows detailed information about your policy. If, for some reason, you cant get a letter of experience, the other main way to check your claim history is to order a Comprehensive Loss Underwriting Exchange (CLUE) report.

What is claims history reporting?

An insurer may request a CLUE report when you apply for coverage or request a quote. The company uses your claims history, or the history of claims at a specific property, to decide if itll offer you coverage and how much youll pay.