Information Requests Claims History & Coverage Verification Requests Thank you for contacting Curi for Claims History/Coverage Verification. Please complete the following information so that we may service your request. You should receive the requested information within 3-5 business days. Request TypePurpose*Individual Physician Claims History/Coverage verificationGroup Claims History ReportRequestor InformationName*Affiliation*(Name of the organization requesting information)Email* Phone*Email group report to* Insured InformationFirst name*Middle nameLast name*SuffixNPI number (if known)Client ID (if known)Policy number*Policy number(s)*(If multiple policy numbers, separate with a comma, for example: "PG12345, PG67891")Policyholder name*Policy state*(Select the policy state)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificAttach a release form for your request*If you do not have a standard release form, download this sample form Accepted file types: pdf. This iframe contains the logic required to handle Ajax powered Gravity Forms.