What is it?
This form serves as a means for medical credentialing offices, practitioners, and hospitals to request claims histories on individuals that have applied/reapplied for staff membership, clinical privileges and/or permission to provide services at a facility. The form serves as a tool to collect necessary information about individuals requiring information for medical credentialing.
Who is Eligible to use it?
Anyone who need claims verifications - within and outside of the University.
Service Availability
Monday to Friday - 8 am to 5 pm