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 verification Group Claims History Report Requestor InformationName* Affiliation* (Name of the organization requesting information)Email* Phone* Email group report to* Insured InformationFirst name* Middle name Last name* Suffix NPI 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, Max. file size: 50 MB.