I need a document verifying coverage for credentialing and hospital privileges that includes details on claims. How do I go about having this information sent to a third party?
A. The information contained in these verification documents is of a confidential nature so we require a written request from you in order to release it in your behalf. Please download the “Claim History Authorization” [PDF] form and print it. Complete the form, sign it and send it back to Medical Mutual via standard mail or by fax. If you need this information sent to more than one entity, please submit a completed form for each party. Once the completed form(s) is received we will forward the verification documents to the third party that you’ve identified.
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